Health Informatics

Dr Hatem El Bitar
lecturer in
BRITISH BOARD,HARVEST
,GMS,SPC,CMT ACADMIES
Diploma of
Hospital Management
 What is Health Informatics?
Simplistic definition:
 It is the application of computers,

communications and information

technology and systems to all fields
of medicine - medical care, medical
education and medical research.
 It is the branch of science concerned with
the use of computers and communication
technology to acquire, store, analyze,
communicate, and display medical
information and knowledge to facilitate
understanding and improve the accuracy,
timeliness, and reliability of decision-
making.
Warner, Sorenson and Bouhaddou, Knowledge Engineering
in Health Informatics, 1997
‫ما هي المعلوماتية الصحية؟‬
‫المعلوماتية الصحية ‪:‬علم تقني اجتماعي‬ ‫‪‬‬
‫متطور يعتمد على تقنية المعلومات‬
‫واالتصاالت ويتميز ببحثة عن الكيفية‬
‫المثلى لجمع وتخزين واسترجاع وتحليل‬
‫وادارة المعلومات في المجاالت الصحية‬
‫المختلفة‪.‬‬
‫اضافة الى ذلك فالمعلوماتية الصحية علم‬ ‫‪‬‬
‫يستخدم احدث اساليب تقنية المعلوماتية‬
‫المبنية على اسس طبية وادارية تطبيقية‬
‫متطورة لتقديم المعلومة الصحيحة في‬
‫الوقت المناسب وللشخص المناسب اليجاد‬
‫الحلول المناسبة واتخاذ القرارات الصائبة‪،‬‬
‫متالزمة مع تقديم الجودة الصحية الفائقة‬
‫لالرتقاء بالخدمة الصحية للمجتمع‪.‬‬
 It is a fact that Healthcare services
are the most complex large scale
business of any country‟s economy .
 An inter-operable system of health
information exchange is required… a
"medical Internet“.
 Aims of Health Informatics:
1. Organizing and managing healthcare
2. To get the right information, for the

right patient, at the right time and

place .
 What can Health informatics do?
•Save us time
•Better quality of information
•Consistency
• Both data and knowledge can be stored on the
computers
• Computers can assist human thinking !!
• Computers are good in generalized modeled
problems
• Helps in Unexpected situations
• Creativity
• risk taking
• help in all decision making and human activities
related to medical problems
 In recent years, research in Computer
Applications applied to Health Care has
dramatically progressed.
 Advances in Information & Communication
Technologies have provided the tools and
environment to study, analyze, and better
understand complex medical problems.
Why computers???

Patient numbers
In ER
=1234\year
Try to remember
 Why computers???

Patient numbers
In IN PATIENT
=12345\year
Try to remember
 Why computers???

Patient numbers
In opd
=123456\year
Try to remember
 Why computers???
 AS YOU CAN SEE
 EVERY TIME THE NUMBER
INCREASES,OUR ABILITY TO
REMEMBER IT DECREASES
 THE NEED FOR SOME TOOLS TO
MEMORIZE ALL THESE STUFF
INCREASES
 THE ANSWER IS COMPUTER
Information and Communication
 Health informatics is both an art & science
 It is not totally dependent on technology
ONLY
 BUT ALSO,
 1-Humans process information
 2-Computers process data
 3-Computers can amplify your brain
 4-abilities of memory, data processing,
accuracy and consistency, just like a
microscope or a stethoscope
Human-computer co-operation
 Advantages of Computer
Technology in Health Care
 The key benefit of using computers in health
care has been the ability of the caregiver to
access patient data and medical information
remotely - whether at home, in their private
office or out of town .
Other benefits include:
.1Improving the effectiveness of the
clinical decision-making process .
This should lead to:
 higher efficiency of that process
 fewer errors should be made
 fewer resources should be consumed.
.2An electronic record system should
enable physicians and nurses to
make better, quicker decisions by
means of:
• on-line access to evidence-based results for
designated disease conditions ،
• assistance in placing orders (detecting a drug-
interaction before the order for a medication is
actually placed ،)
• receiving an alert electronically after a significantly
abnormal test result.
3. providing advanced health care
services
eg. Computer Aided Radiology,
Computer Aided Surgery,
Telemedicine, Robotized Tele-
operating Systems, etc.
4. Research and Development
 Limitations
 Creative thinking is not something that
computers are good at
 Data Collected must be Accurate, Correct,
Complete, and Precise
 Systematic errors and statistical errors
can occur
(Think about how accurate are the blood
pressure measurements?)
(What is missing, what is not important,
what is normal: we can not tell from the
patient records)
lecture2
 Medical informatics has to do with
all aspects of understanding and
promoting the effective
organization, analysis,
management, and use of
information in health care.
 While the field of medical
informatics shares the general scope
of these interests with some other
health care specialties and
disciplines,
 medical informatics has developed
its own areas of approaches that
Human thinking and computers:
 Conscious thinking and reasoning
characteristically precedes most
technological activity
 This applies to daily technological products
as well as to scientific activities.
 Patient care and medical research are
examples of areas in which human
reasoning is important. In principle, both
data and knowledge can be stored in
computers.
 This is why human reasoning can now be
assisted by computers.
 Data and information:
 Information plays a key role when
interpreting data and making decisions.
 therefore it is essential to know
 what information is?,
 and what the difference between data,
information, and knowledge?.
 how reliable data can be acquired?
 in what way information is derived from the
data?
 what type of knowledge is necessary for
interpreting the data
 and how this knowledge can be stored in
computers.
 Figure 1 shows that the patient or some
(biological) process generates data that are
observed by the clinician.
 From those data,
by a process of
interpretation ,
information is
derived,
 This information
guides the
clinician in taking
further action.
 The arrow labeled
"information"
indicates the first
feedback loop to
the clinician.
 By carefully studying many such
interpretation processes in medicine or by
collecting interpreted data from many
patients, inductive results may lead to new
insights and new knowledge.
 This knowledge is then added to the body of
knowledge in medicine and, in turn, is used
to interpret other data.
 Computers may help in the collection and the
interpretation of the data and then add to our
new knowledge.
 both data and knowledge can be stored in
computers, and computer programs can be
developed for the acquisition and the
interpretation of the data.
 Diagnostic-Therapeutic Cycle:
Stages in human activities
In almost all human activities we can see three
stages:
 observation,

 reasoning,

 action.

 These stages in human activity play a role not only

in daily life, but also in patient care, management,
and research.
 For instance, if we find ourselves in a dangerous or
unpleasant situation, we observe the facts and the
circumstances, make a plan to get away from the
problem and, if possible, carry out our plan to
improve the situation.
•The same three stages can also be seen in
scientific research (Table 1).
•The investigator collects the observations
(measurements or data), arrives at a conclusion
in view of hypotheses and, on the basis of his
theoretical knowledge and reasoning, comes to
an interpretation and rejects or revises the
theory, and, finally, plans new investigations or
experiments to widen his or her knowledge.
 Reasons for Storing Medical Data
in a Computer
Application areas Advantages of coding medical data

 Patient care  Data reduction

 Quality control by:  Standardized terminology
 uniform reporting of results  Enabling statistical overviews and
 comparing data with those from research
other units or centers  Support of management and planning
 protocol management  Coupling with decision-support systems
 increased insight
 Medical research, including
epidemiology
 Planning and management

With the present-day computers and PCs, it is possible to store an

extremely large amount of data at a cheap price, and these data
can be retrieved quickly.
 Types of Information Systems in
Health Care:

There are two main types of

Information Systems in Health
Care:
1. Medical Information Systems

2. Health Information Systems

1. Medical Information Systems
Are also subdivided into two types:
a. Clinical Information Systems
b. Laboratory Information Systems
 a. Clinical Information Systems
Different medical specialties each
have their own ways or methods of
medical informatics
Eg. Cardiac: ECGs, Echocardiographs,
halter-monitors
Eg. Surgery: Robotic surgeries.
 b. Laboratory Information Systems
 Main two divisions are:
i. Radiological Information Systems
ii. Pathological Information Systems
i. Radiological Information Systems:
Digital computer applications in
terms of digital x-rays, ultrasound,
Ct scans, Dopplers, etc
Each of these systems are made by
different companies, such as Muse
(USS), Siemens, GE, Kodak.
ii. Pathological Information Systems:
 Blood transfusions

 Microbiologic results

 Anatomical/pathological results
 2. Public Health Information
Systems
 Epidemiological Information
 Biostatistics
 Creation and keeping of databases
 Databases
 Databases of patient data are in use in hospitals,
clinical departments, and primary care practices
and are used for statistical purposes.
 In ancillary departments databases are also used
to control the stock of goods necessary to run an
institution.
 Several institutions serve health care by
providing central databases and systems where
knowledge is stored. This knowledge can be
borrowed for the benefit of patient care or
research.
 Eg. MEDLINE of the National Library of Medicine
in the United States, national databases of drugs,
or international databases for the storage of
diagnostic codes, such as the International
 Nowadays medical imaging systems
increasingly deliver pictures in digital form
 computer memories are becoming steadily
larger and have lower prices,
 Picture archiving systems (PACS) are now
also more affordable, and PACS have
begun to be implemented in departments
of radiology.
 In several countries, national databases
are constructed for management and
planning or, increasingly, for the quality
assessment of care or post-marketing
surveillance of drugs.
 Research
 Scientific research and its complement are
the most important issue leading to the
development of new methods.
 In medical informatics there is a great
need for basic and applied research and
the development of methods that are
based on such research.
 The object of research in medical
informatics, is to investigate processes to
be able to describe them, to develop and
assess models, and to develop processing
systems.
 Computer Programs in Health
Models of computer programs are required
for:
 Level 1: the electronic interchange of
medical data
 Level 2: departmental information
systems or computer-based patient
records
 Level 3: the three-dimensional
reconstruction (3-D reconstruction) of
medical images,
 Level 4: the interpretation of ECGs or the
differential diagnosis of abdominal pain,
 Level 5: therapeutic support by critiquing
systems
 Level 6:
 Development and validation of different
models underlying computer-based
patient records and models that support
sharing of patient data.
 The use of computers for the analysis of
data acquired in epidemiological studies,
for example, by using database
management systems, statistical
methods, spreadsheets, and graphical
presentation software.
 Computer models for the electric
depolarization of the cardiac muscle: may
give more insight into the functioning of
the heart and lay the foundation for a
better interpretation of ECGs.
Level 6 )Cont…):
 Models for the investigation of nervous or
hormonal control systems of the
circulation, to study different control
systems and their interconnection.
 Computer models enable verification of
hypotheses and preparation of protocols
for in vivo experiments.
 The use of virtual-reality models in
surgery, for training (comparable to flight
simulators) or to assist surgeons in so-
called minimal invasive surgery.
 Research and development for the
realization of systems on all five levels is
done on level 6. Here, in fact, human
ingenuity and creativity reach their climax.
 Computer models may assist with the
verification of theoretical assumptions,
 in the assessment of ideas for the
development of information processing
systems.
 In experiments with patient databases,
hypotheses can be tested and models
can be validated.
THANK
YOU
 Lecture 3

Systems in Health care

Systems theory: Provides the
conceptual foundation on which
the development of information
systems is based.
A variety of systems comprise the
functioning of healthcare
organizations, and can be
categorized into three groups:
1. Mechanical,

2. human,

3. and man-machine systems,

1. Mechanical systems: integral part of the
physical plant, eg. Heating, cooling, monitoring
temperature, pressure, humidity, and supplying
chilled and heated water.
2. Human systems: carries out most essential
functions: organized relationships among
patients, physicians, employees, family
members of patients, and others, nursing care.
3. Man-machine systems: with the development
of modern information technology. Are formally
defined systems in which human effort is
assisted by various kinds of automated
equipment. Eg. Computer systems have been
developed to monitor the vital signs of critically
ill patients in intensive care Units.
 Information systems in healthcare
organizations fall in the second and
third category of this simple
distribution.
 will be either human systems or
systems designed to support
operations.
1. Manual IS: Are IS that operate
without any kind of machine
processing of data.
2. Computer-aided IS (man-machine)
General Systems Theory:
 Social scientists have defined systems in various
ways.
 Definition: a system is a set of objects, and the
relationships between the objects and their
attributes.
- Objects: constitute component parts of the
system
- Attributes: are the properties of these objects
 Defined relations tie the component parts
together, thus making a greater unity.
 Relationships can be planned or unplanned,
formal or informal, but they must exist if the
collection of components is to constitute a
system.
Systems analysis:
 is a fundamental tool for the design and
development of information systems.
 It is the process of studying organizational
operations and determining information
system requirement for a given
application.
 Systems analysis employs concepts from
general systems theory in analyzing
inputs, processes, outputs, and feedback
in defining requirements for an
information system.
Certain basic concepts:
1. A system must have unity or
integrity: This means that a system must
be something that can be viewed as an
entity in its own right, with unity of
purpose in the accomplishment of some
goal or function.
2. Systems at work in healthcare
organizations are very complex: The
intricate web of complex relationships that
constitute most social systems makes it
difficult to describe simple cause-and-
effect relationships among individual
components of the system.
 Complex systems are further defined by their
hierarchical structure; that is, large systems in
healthcare organizations can be divided into several
subsystems, and these subsystems in turn are
subject to further subdivision in a nested format.
Eg. the patient care component of an integrated
delivery system is composed of several subsystems:
a diagnostic subsystem, a therapeutic subsystem, a
rehabilitative subsystem, and so forth.
Each of these subsystems in turn can be further
described by a series of smaller systems. The entire
network of systems and subsystems nests together
in a structured way to describe the patient care
system of the organization (see Figure 2.2).
3. They must posses some stability
and equilibrium, in spite of their
being dynamic and subject to
frequent change.
The system must continue to
function in the face of changing
requirements and changes in the
external environment in which it
operates. When the system can no
longer adapt to changing
requirements or major changes in
the external environment, it no
longer functions as a system, and
4. Systems can be either
deterministic or probabilistic:
 In a deterministic system, the component
parts function according to completely
predictable or definable relationships.
Most mechanical systems are
deterministic.
 On the other hand, human systems or
man-machine systems (including
information systems) are probabilistic
because all relationships cannot be
perfectly predicted. In healthcare
organizations, for example, most clinical
systems are subject to fairly extreme
fluctuations in the quantity and nature of
the demand for patient services.
5. Systems are either open or closed. A
closed system is completely self-
contained, and is not influenced by
external events. In an open system, the
components of the system exchange
materials, or information with their
environment; that is, they are influenced
by, and themselves influence, the
environment in which they operate.
 All closed systems eventually die (cease to
function as a system). Only open systems
that adjust to the environment can survive
as systems over time.
6. Most systems also involve
feedback.
 Feedback is a process by which one

or more items of output information

“feeds back” and influences future
inputs.
Systems Characteristics

The simplest of all systems consists

of three essential components: one
or more inputs, a conversion
process, and one or more outputs.
(Figure 2.3).
Consider for example the appointment-
scheduling process of an ambulatory care
center as a simple system.
 Inputs to the system consist of appointment
requests from patients; physician schedules;
and clinic resources, including personnel,
treatment rooms, and supporting materials.
 The conversion process includes a set of
actions: the scheduling clerks collect
information from patients, match patient
requirements to available time slots, and make
appointments.
 Output of this simple system consists of
patients scheduled for service in the clinic.
Note that the output of this system becomes
the input for several other functional systems
of the clinic—medical records, patient
accounting, and others.
In the example just cited, feedback will occur in the
form of adjusted information on the number of
time slots available as patients are scheduled for the
clinic. Each time an appointment is made, input data
on times available are revised and updated. (Figure 2.4).
 Environmental Factors in open
systems:
Human or man-machine systems in healthcare
organizations are influenced by a variety of
environmental factors (exogenous factors or
variables).
These environmental factors fall into four broad
categories.

1. Social factors: characteristics of individuals and

groups of people. Social factors affect patient
behavior and patterns of utilization of services
2. Economic factors: systems are directly
dependent on the availability of resources.
Fluctuations in local and national economy will
influence both demand and resources.
3. Political factors.
4. Physical environment: The amount of space
available and the way in which system
components relate physically to each other will
 Cybernetic System:
 cybernetic or self-regulating system. Figure 2.6 is
a generalized diagram of a cybernetic system.
 Feedback is controlled to adjust the future
functioning of the system within a predetermined
set of standards.
 The following components are added to the
general system components to provide this
automatic control:
1. A sensor element continuously gathers data on
system outputs
2. Data from the sensor are fed into a monitor for
continuous matching of the quantity or quality, or
both, of performance against standards—
predetermined expectations of system
performance
3. Error signals from the monitor are sent to a
control unit, whose purpose is to generate
correctional signals that automatically modify
inputs and conversion processes to bring the
functioning of the system back into control
 The most often-cited example of a
cybernetic system is a thermostatic
control system for the automatic
heating and cooling of a building.
The sensor unit continuously
measures ambient temperature and
sends signals to the monitor that
compares the current temperature to
preset standards. Through the
control process, automatic correction
signals are sent back to the
heating/cooling units of the system
to keep the temperature within
control limits.
 Database systems
“Give me a list of all patients younger
than 12 years who were admitted to
the pediatric infectious diseases clinic
by Dr. Galal during 1999-2000 and
who were hospitalized more than 10
days, present the data grouped
according to their place of birth and
sorted by the mean temperature of
the patient”
THANK YOU
 Lecture 4

Computer Hardware
 Computer Hardware
 As health personnel, you must have at
least a basic understanding of computers
and their components.
 This lecture discusses the physical
components that comprise a computer
and the physical devices that combine to
form a computer system.
 These components and devices are known
collectively as hardware.
 The personal computer, or PC, used by a
large segment of the population is an
example of computer hardware.
 An Overview of Computer Components
 A Computer is an electronic, digital device
characterized by its ability to store a set of
instructions known as a program, as well as the
data on which the Instructions will operate.
 The first such device was built in the United States
known as The Electronic numerical Integrator and
Calculator (ENIAC), and was completed in 1946 at
the University of Pennsylvania, launched the first
generation of computer hardware.
 Today, more than half a century later, the
computer world has evolved to the fourth
generator of hardware.
 Although computer hardware evolution has been
quite impressive, the basic schematic of a
computer remains the same. Figure 3.1
 Six categories of components
comprise this system:
1. The central processing unit,
2. Primary storage.
3. Secondary storage,
4. Input units.
5. Output units, and
6. Communications devices.
The communication devices are the
hardware that allows the computer to
communicate with other computers, either
within the organization or external to the
organization. Such communication gives rise
to the concepts of networking and
 I. Central Processing Unit
 The central processing unit (CPU)
might be called the „brains” of the
computer.
 Here is where the actual “computing”
rakes place.
 The CPU consists of three major
subcomponents: the arithmetic logic
unit, the control unit, and registers.
1. Arithmetic/Logic unit:
 The basic computational and comparison
capability of the computer lies in the ALU.
 The ALU has the ability to perform
addition, subtraction, multiplication and
division.
 It is capable of performing these
operations quite rapidly.
 In addition, the ALU can perform the
logical operation of comparison—that is
determining if two quantities are equal or
if one is greater than the second.
2. Control Unit:
 If a problem is described to the computer in any
language, the problem description is converted to
a series of machine instructions that the
computer is able to understand. The instructions
are stored in primary storage.

3. Registers:
 When program instructions or data are
transferred from primary storage to the CPU for
processing, they are held in a high speed
memory area within the CPU known as registers.
 Figure 3.2 illustrates a popular microprocessor
CPU.
 II. Primary storage
 Small silicon chips (known as semi-conductors)
have replaced the early magnetic cores as the
basis for primary storage.
 Numeric data are stored as their binary
equivalent
 Non-numeric data are stored as unique binary
values distinguishable from numeric data.
 Each digit in the binary system is known as a bit.
 The bits of a word are separated into groups of
eight bits and is called a byte.
 A group of 1000 bytes are known as kilobytes.
 The amount of primary memory in today‟s
computers continue to increase.
Types of Primary Storage:
 Read-only memory (ROM): contents of this type
of memory can be read, but nothing can be
written in these storage locations. Are used to
store small sets of instructions used by the
computer to perform specific tasks eg. Sequence
followed when the computer is turned on.
 Random- Access Memory (RAM): Constitutes the
majority of primary storage. RAM holds data and
program instructions until needed for processing.
Is volatile memory so that its contents are lost if
the computer is switched off.
 Cache memory: speed is much higher than RAM.
Is used with other computer components.
 III. Secondary Storage:
 Large capacity, non-volatile storage
media, from which desired information are
obtained as necessary
 Types:
 Magnetic tape: Older secondary storage.
Like tape used in reels. Advantages low
cost, relative stability and large storage
capacity. Disadvantages slow speed, are
sequential devices such that you have to
start reading the tape from the beginning
each time you are looking for particular
information.
 Magnetic discs: most widely used today.
Rigid (hard disc) or flexible (floppy disc).
 Optical discs: stores a large amount of information on a
relatively small disc eg. Compact Disc Read-Only Memory
(CD-ROM), Compact Disc-Recordable (CD-R), Compact Disc
Rewritable (CD-RW), and digital versatile discs (DVD).
(Figure 3.5). CD-ROM disk can store up to 300,000 pages
of text, it is ideal for storing bibliographic material, journal
articles, meeting abstracts, and government reports. In
addition to text, color photographs, video clips, animations,
stereo sound, and software are being released in this
medium. CD—ROM was used in an interactive computer
based educational program for heart-failure patients A CD—
ROM database plays a key role in helping Air force
personnel monitor their behavior while receiving nutrition
counseling for weight loss.
CD-ROMs originally were used in audio applications where
the „data‟ on the disk were typically accessed sequentially.
In fact, the CD— ROM drives used in computers are capable
of reading” audio compact disks
 Magneto-
optical discs:
Written data,
large memory,
stores large
amounts of
data from
several
sources, Optical
jukebox
storage system
(Figure 3.6).
 Optical or laser cards: similar to a small credit
card. Uses a laser to permanently store data.
Data are unerasable, but new data can be added.
Can link patients and hospitals.
 Smart cards: Like a laser card, a smart card also
resembles a plastic credit card. The smart card
has an embedded computer chip that can store
information, process information or serve as a
key to an online database or network. These
cards can potentially store an individual‟s medical
record, determine eligibility for specific
procedures, and even maintain a cash balance to
cover insurance copayments as needed. Of
course, if the patient has lost or forgotten either
type of card when care is sought, previous
 IV. Input Units:
 The power of an information system can
only be realized when data and programs
have been entered into its storage.
 Techniques used to input data today are:
 Keyboards: For entering data into the
computer. Similar to a typewriter but has
extra keys with special characters or
commands
 Pointing devices: Mouse/ball
 Scanning devices: used to scan documents from the
healthcare institution into the computer. Printed labels
containing sets of vertical black/white bars can be read by a
bar-code scanner. (Figure 3.8). For documents containing
special characters or codes, special forms such as
questionnaires or evaluation
and documents containing text and/or graphics. Barcode
printers may he used to print barcodes for pharmacy
prescription dispensing and inventory, laboratory tests,
equipment Inventory, medical records, and other areas.
The scanning itself may be performed using a barcode
wand connected to a computer with an interface cable) or a
wireless handheld unit, containing a wand or built-in gun-
type scanner, which transmits data to a central computer.
Optical scanners can be used to enter a variety of source
documents containing both text and graphics. These
scanners lie at the heart of document-management system
that uses “digital scanning devices to convey paper
documents into digital image files that can be electronically
stored, transmitted and displayed.
 Handwriting recognition: Writing
data directly onto a special screen.
small devices like the personal digital
assistant (PDA)
 Voice input.
 V. Output Units:
 An important objective of information
systems is to produce output of value to
the user.
Types of Output:
1. Visual displays: Oldest is the Video
Display Terminal (VDT) or monitor. Two
important characteristics are screen size
and resolution.
2. Printed output: Printers have developed
extensively; dot matrix printers, inkjet
printers, & laser printers
3. Voice output: The digital text of the
computers memory is converted to
understandable speech by means of a
 Classes of Computers:
1. Supercomputers: used in military and
scientific applications. Able to perform a
large number of complex calculations with
considerable speed.
2. Mainframe computers: Centrally located,
large size, fast speed, primary storage of
several hundred megabytes, online
secondary storage of billions of bytes.
3. Minicomputers: physical size and
computing capability between the
mainframe and the microcomputer.
4. Workstations: high end microcomputer,
with a large amount of primary storage, a
fast processor, high quality sound card, a
CD-RW drive, and in many cases a DVD
drive. Eg. Radiology Imaging Units.
5. Personal computers: Smaller versions of
microcomputers are gaining popularity in
the health care setting. These include
laptop computers (about the size of a
small case), notebook computers (about
the size of a small three-ring binder),
palmtop computers (able to be held and
operated in a single hand), and personal
digital assistants (PDAs, see Figure 3.9).
 Summary
 Computer hardware spans a broad spectrum,
from small palmtop computers that can be held
in one hand to extremely large and powerful
supercomputers.
 No matter where on the spectrum a given system
lies, it is composed of six basic components: a
CPU, primary storage, secondary storage, input
units, output units, and communications devices.
The CPU is the “brains” of the computer and its
speed and power greatly influence the computer‟s
capabilities. The capacity and speed of the
primary storage also affect the computer
system‟s performance, and fortunately the cost of
this component is generally falling.
 Secondary storage devices include a variety of
disk and tape units and are designed to maintain
the large quantities of data common to
healthcare applications. Optical storage has
become more prevalent and is increasingly
important. The speed with which data are
entered into and retrieved from secondary
storage devices is also an important specification
within the overall system.
 A number of peripheral devices are available to
facilitate the process of entering data into the
computer in a variety of formats, including
keyboard entry, scanning, and voice input.
Similarly, data can be obtained from the
computer on a display screen, in printed form,
magnetically for future processing or in spoken
form. The goal of the industry is to make data
 Computer hardware technology
changes at such a rapid pace that
keeping up is difficult even for the
information systems specialist, let
alone the healthcare manager. Like
any other investment decision,
consideration must be given to the
size and power of the computer that
is appropriate for any given
application.
THANK YOU
 lecture 5

medical Informatics
Computer Software
 Computer Software
 Software is a synonym for computer
programs.
 This lecture presents some understanding
of basic software concepts, including a
description of application software, the
role of system management software, an
introduction to programming languages,
and the functions of language translators.
 Application Software
 The most important category of
software is application software.
 Application software can be further

classified as:
1. General purpose software
2. Application specific software.
 1. General Purpose Software
 Many computer programs provide an
environment in which a user can solve a
particular class of problems rather than a
single, narrowly defined problem.
 Examples include word processors,
desktop-publishing software, spreadsheet
software, statistical packages, database-
management software, presentation
graphics software, and web browsers.
 These programs are most often run today
on a microcomputer.
a. Word Processors:

 The preparation of manuscripts, letters,

forms, manuals, or any material once
completed on a typewriter is now made
easier with word-processing software.
 The power of word processing lies in its
editing capabilities. No need to retype a
page to make a simple correction.
 Other capabilities that contribute to the power of
word processing include:
• the ability to merge form letters with a list of
addresses,
• the ability to insert graphical images or figures
into a document,
• the ability to easily convert a document from
one word-processing format to another,
• the ability to check spelling and grammar,
• the ability to use a thesaurus for determining
synonyms, and
• the ability to create tables and perform basic
arithmetic operations on the values in a table.
 Popular word-processing programs include
Microsoft® Word and Corel® WordPerfect.
b. Desktop Publishing Software:
 Are slightly more powerful than traditional word-
processing software.
 Desktop-publishing software is designed to create
camera-ready copy of newspapers, invitations,
programs, bulletins, and other similar documents
typically produced by typesetting just a few‟
years ago.
 An important feature is its ability to support a
wide array of fonts so that the desired printed
effect can he achieved.
 Also important is the ability to import
photographs, diagrams, and other figures
 Have the facility to easily combine photographs,
diagrams, and figures with text to produce
exactly the page layout that is desired.
 Popular desktop packages include Adobe®
PageMaker®, QuarkXPress®, and Corel
VenturaTM 8.
c. Spreadsheet software:
 Users can prepare, edit, and print a wide range of
financial, administrative, and other types of
tables with the use of spreadsheet software.
 VisiCalc, as the first spreadsheet program was
called, clearly demonstrated that a computer
could he used to perform functions useful to the
organization without a need for in-depth
programming skill.
 On starting (or “booting-up”) a spreadsheet
program, the user is presented with a rectangular
array of cells (see Figure 4.1). Numbers,
formulas, functions, or clusters of instructions
(called macros) can be entered into the cells.
 All of the standard mathematical operations can
be performed on the cell values, and the results
of these operations change if the cell values
involved in the computations change.
 The spreadsheet formulas are written in terms of
constant values and/ or values located in other
cells. If a cell value changes, all of the cells
containing formulas involving that modified cell
will also change. This property gives the
spreadsheet much of its power.
 Today‟s spreadsheet software has a number of
additional features that include creation,
insertion, and printing of graphs into the
spreadsheet; text enhancement, such as cell
shading, outlining, underlining, and multiple
fonts; data import and export to and from other
file formats; and data-editing capability.
 In addition, the software can perform
sophisticated statistical and economic analyses,
database functions, and optimization.
 Popular spreadsheet programs include Lotus® 1-
2-3, Quattro® Pro 10, and Microsoft® Excel.
d. Statistical Packages:
 The analysis of data has been greatly simplified
by the availability of a wide
range of statistical packages.
 The term statistical package is usually applied to
software specifically written to perform statistical
computations.
 With this software, users can easily enter raw
data, make changes as necessary, sort the
values, create subsets of the data using a
specified criterion, merge data sets, and perform
a variety of analyses and high-quality graphs.
 Popular statistical software packages include
SPSS (SPSS Inc. 2002); SAS (SAS Institute, Inc.
2002); Statgraphics Plus (Manngistics, Inc.
2002); and StatView (SAS Institute, Inc. 2002).
e. Database-management software:
 Allows users to easily interact with databases

 Databases are organized collections of files that

are designed to provide easy access to
Management needed information.
 This software makes it relatively straightforward
to enter Software data, edit the data, and create
reports based on those data to answer specific
questions of interest.
 For small projects or studies, database-
management software, functions similar to a
spreadsheet or statistical software.
 Once the user has created a database, the
software supports a variety of functions including
data editing and printing, extraction of a subset
of records based on one or more criteria, creation
of reports, data import/export to and from other
file formats, and an easy-to-use file record query
language.
f. Presentation Graphics Software
 Slides that are presented in meetings can
be created and displayed with
presentation
graphics software (see Figure 4.2).
 This software allows the user to create
custom slides with any desired text, chart,
graphics, or picture.
 Sophisticated graphic effects such as
dissolves, fades, or animation as well as
audio effects can be incorporated into the
presentation.
 Microsoft‟s PowerPoint is a commonly used
presentation graphics software product.
g. Simulation Software:
 Simulation is a problem-solving approach
in which the decision maker performs
sampling experiments on the model of the
system being studied rather than the
system itself.
 Other features include animation,
graphical interfaces, built-in probability
distributions, standard reports, and the
ability to export results to programs such
as Microsoft® EXCEL.
 Examples of simulation software are
MedModel® and Extend®.
h. Integrated Software Programs:
 Integrated software programs consist of a
series of menu-driven module programs,
all in the same software package.
 Module packages may include word
processing, spreadsheet, database,
graphics, communications, and Internet
hooks among others.
 Frequently used integrated software
packages include Lotus Smart Suite,
Microsoft, and Corel WordPerfect Office
Suite.
II. Application -Specific Software
 The term app1iction-specific software denotes a
computer program that has been designed to
solve a single, specifically defined problem.
 A good example is a payroll program, which is
developed to accumulate labor hours, compute
deductions, write payroll checks, post summaries
to the general ledger, and complete the several
forms that are required by federal and state
governments.
 The following table displays the categories into
which Healthcare Informatics classifies
application-specific software.
 Healthcare organizations have the option
of developing application- specific
software in-house or purchasing (or
leasing) a “package” and simply installing
it on their computer system.
 Factors that must be considered when
choosing application software are the
required staffing and equipment
resources, the cost of maintenance,
complexity of the operations being
automated, the number of potential users,
and data security issues.
 III. System-Management
Software
 System-management software is the
group of programs that manage the
resources of a computer system and
perform a variety of routine processing
tasks.
 Unlike the role of application software, the
function of system-management software
is often not obvious to the user.
 Two components: the operating system
and utility programs.
A. Operating Systems:
 Operating systems serve as the interface
between the human user and the computer.
 Types of services provided by an operating
system, include:
• managing the sharing of internal memory
among multiple applications;
• handling input and output to and from attached
hardware devices such as hard disks, printers,
and dial-up ports; and
• displaying messages about the status of the
operation and any errors that may have
occurred.
 Three operating systems illustrate the range of
such systems across the micro-, mini-, and
mainframe-computer lines:
1. Windows XP Professional:
 Illustrates a popular microcomputer
operating system for the business
community.
 It is designed to manage system
resources, such as memory, CPU time,
and file operations, in a way that results in
very efficient multitasking.
2. UNIX:
 Is an operating system originally
developed for mid-sized minicomputers
that now runs on many microcomputers
and mainframe computers as well.
 It has a command set that is, in many
ways, similar to DOS (the PC-based
operating system that preceded Windows)
but is more robust for multi-user
applications.
 The operating system coordinates the use
of the computer‟s resources, allowing
multiple users to perform a variety of
tasks with each user believing that he or
she is the only person working on the
computer.
3. MVS:
 Has been said to be the operating system that
keeps the world going.
 It supports large, complex computer systems and
offers support for a wide range of input/output
facilities, for CPU multiprocessing, and for system
interconnection.
 Installations with large mainframe computers
using the MVS operating system must he willing
to commit to significant personnel to support the
system operations.
 B. Utility Programs:

 Utility programs are software

packages that perform generalized
data processing or computational
functions on computers.
 They offer general utility and support
to a variety of information-
processing tasks.
Utility programs fall into three general
categories:
1. Programs that support computer
operations: Examples include programs that
save and provide backup copies of computer
programs written by users and programs that
perform operational housekeeping tasks such as
disk formatting.
2. Programs that provide generalized file
manipulation: Examples include generalized
database-management systems and programs
that sort or merge records in files.
3. Generalized computational programs:
Examples include packages of mathematical
subroutines that perform complex operations that
can be called by application software.
THANK YOU
 lecture 6

medical Informatics
Computer Software
part 2

An Introduction to Programming
Languages
 All software—application, system, or utility—
consists of a detailed set of instructions
describing the specific steps that the computer is
to perform.
 Just as two people communicate in a specific
language, this detailed set of instructions must
also be communicated to the computer in a
specific programming language.
 The material presented in this section provides
useful background material for a fuller
understanding of software.
 The format of a particular
programming language is known as
the syntax of that language.
 If, for example, the programming
language syntax calls for a comma at
a particular point in the
“conversation,” omission of that
comma can lead to unpredictable, if
not disastrous, results.
 A discussion of computer
programming languages can be
organized along a time
continuum: Each decade between
the 1940s and the 1980s roughly
marked the beginning of a new
“generation” of programming
languages.
 These four generations of
programming languages are
summarized in the following table:
TABLE 1: Four Generations of Programming
Languages

Generation General Characteristics

Machine language;
1
strings of zeros and ones
Assembly language;
2
uses mnemonics
Procedural languages;
3
focuses on solution to problem
Variety of application and program-generating languages;
4
focuses on description of problem itself
First-Generation Programming Languages:
 When computers were first developed, users
needed to provide instructions in machine
language, which consisted of strings of zeros
and ones.
 The collection of strings understood by the
computer is known as that computer‟s instruction
set and allows the user to perform a variety of
arithmetic operations, data comparisons, and
data movement within the computer‟s central
processor and memory.
 Machine languages represent the first generation
of computer programming languages.
 Learning the complex sequences of zeros and
ones was difficult to the average prospective
computer user.
 It was obvious to computer developers that their
widespread use would occur only if
communication with them were made easier.
Second-Generation Programming Languages:
 An assembly language essentially replaces a
string of zeros and ones with an alphabetic
symbol known as a mnemonic.
 For example, the “code” for addition might be
AD, for subtraction SUB, etc.
 Were somewhat easier for the user to learn,

 The set of instructions written by the user in an

assembly language needed to be converted or
translated to the binary codes recognized by the
computer (zeros and ones), which was done by
special software.
 The tedious process of constructing a sequence of
mnemonics to describe a problem was still
difficult.
Third-Generation Programming Languages:
 The third generation of programming languages
was procedural, and high-level.
 The term procedural signifies that these
languages still require the user to describe to the
computer the detailed solution steps that are to
be followed in a structured format.
 However, the term high level indicates that the
format of the user‟s description resembles the
language of the problem more closely than do the
zeros and ones of machine language or the
mnemonics used in an assembly language.
 Table 2 presents a summary of representative
third-generation languages, and a brief
description of each is presented below.
TABLE 2: Representative Third-Generation
Languages
Language Major Characteristic
FORTRAN Early scientific language
COBOL Early business-oriented language
ALGOL Influenced the development of several
contemporary languages
PL/i Intended to combine best features of
FORTRAN, COBOL, and ALGOL
BASIC Important language in early days of
personal computing
MUMPS Specifically developed for use in
(renamed M) healthcare environments

Pascal Replacement for BASIC that is suitable

for business and scientific applications
C Suitable for business and scientific
(newer version applications;
C + +) allows operations close to machine
language
FORTRAN:
 Appeared in 1957, known as FORTRAN (an
acronym for FORmula TRANslation).
 Scientists and mathematicians quickly
preferred this language because of its use
of mathematical notation.
 The language has undergone many
revisions, and maintains its popularity for
numerical analysis.
COBOL:
 Shortly after release of FORTRAN, a committee
of representatives from business,
manufacturing, government, and academia was
formed to create a computer language.
 Capable of running on a variety of computers
and uses a syntax closely resembling simple
English sentences.
 Quickly gained popularity among the business
community.
 COBOL has also been revised several times
since its introduction. For nearly three decades
COBOL was used almost universally for the
business and accounting functions in hospitals.
 Nowadays, many healthcare managers are
trying to decide whether to keep these COBOL-
based systems, which typically run on
mainframe hardware, or replace them with
alternative technology.
ALGOL:
 Although never widely used, ALGOL (Algorithmic
Language) was created in 1958 for scientific use.
 Its instructions were “English-like,” and its
statements employed conventional algebraic terms.
 ALGOL greatly influenced the development of other
third-generation languages: PL/1, PASCAL, and C.

PL/1:
 Initially called NPL (New Programming Language).
 PL/1 was intended to combine the best features of
FORTRAN, COBOL, and ALGOL into a single
language attractive to both the scientific and
business communities.
 Not frequently used today, although it has been
used in healthcare settings.
BASIC:
 BASIC (Beginner‟s All-Purpose Symbolic
Instruction Code).
 Was developed in the mid-1960s, and was
a relatively easy high-level language to
learn
 It was intended for use in introductory
computer programming courses.
 Early PC manufacturers included the
BASIC language with their hardware.
 Although the language has had
widespread use among PC users, it has
found little use among serious business
users.
MUMPS:
 The MUMPS (Massachusetts General Hospital Utility
Multi-Programming System) programming
language was developed in the 1960s for
healthcare environments.
 Subsequently renamed M,

 MUMPS is expressly set up for a multi-user

environment.
 MUMPS works well in many healthcare applications
that need multi-user access to many central files
and report generation capabilities, such as patient
admitting and records, patient bed scheduling, and
nurse personnel staffing and scheduling, among
others.
 Successful applications include COSTAR: an
outpatient record system; DXplain: a diagnostic
decision-support system; and a variety of other
systems.
Pascal:
 Developed in the late 1960s,
 Was meant to be a good medium for teaching computer
programming.
 Pascal replaced BASIC as the language taught in many
introductory university computing courses.
 It is well suited for both business and scientific
applications.

C:
 The C programming language was developed at Bell
Laboratories in 1972.
 C is a high-level language that is appropriate for both
business and scientific applications.
 This language is popular because programs written in C
can be run on most computers, a property known as
machine portability.
 In fact, a number of healthcare applications described in
the literature have been developed in the C language or
its enhanced successor, C++.
Fourth-Generation Programming
Languages:
 Fourth-generation languages allow the
user to focus on a description of the
problem itself.
 The computer then determines the
appropriate sequence of operations
necessary to obtain the desired solution.
 As a result, writing a new program is no

longer an activity restricted to professional

programmers or technically trained
individuals.
The Next Generation of Programming
Languages
 Despite the improvements offered by fourth-
generation languages, many people still find
interacting with a computer difficult.
 People would find a natural language much
better, since the user can use it as easily as he or
she communicates with other people.
 Therefore, a translator program is employed to
convert the natural language statements into the
binary number commands intelligible to the
computer.
 The next generation of languages will very likely
focus on natural languages that are essentially
English-language statements.
THANK YOU
 lecture 7

Nursing Informatics

Nursing Information
systems
 Nurses are both: coordinators and
providers of patient care
 Direct care: helping patients cope with
consequences of disease
 Attend to entire patient: psychosocial,
somatic and spiritual needs
 Nursing care requires many dimensions of
patient care that must be visible at the
same time, which puts a large demand on
nursing informatics
 Nursing Informatics is a specialty
of Health care informatics which
deals with the support of nursing by
information systems in delivery,
documentation, administration and
evaluation of patient care and
prevention of diseases.
 Nursing informatics help nurses to
deliver, document, administer and
evaluate nursing care for patients
 Definitions:
 Various definitions of Nursing
Informatics have been proposed;
perhaps the most widely currently
accepted definition comes from the
International Medical Informatics
Association - Nursing Informatics
Special Interest Group adopted
August 1998, Seoul, Korea: Nursing
informatics is the integration of
nursing, its information, and
information management with
information processing and
 A more recent definition of Nursing
Informatics comes from the
American Nurses Association's Scope
and Standards for Nursing
Informatics Practice (2006): Nursing
Informatics is a specialty that
integrates nursing science, computer
science, and information science to
manage and communicate data,
information, and knowledge in
 An early (and still valid) definition
was proposed by Hannah (1985): The
use of information technologies in
relation to any of the functions that
are within the purview of nursing and
are carried out by nurses in the
performance of their duties. This
comprises the care of patients,
administration, education and
research.
 History:
 Development of special information
systems for nurses began in the late
1960s, with gradual emerging of the
principles regarding the development
of nursing support systems.
 Documentation of nursing care
began much earlier, from the
nineteenth century when Florence
Nightingale addressed the question
of why nurses should document their
 In her opinion, such documentation
contributes to the proper care and
healing of the patient. She addressed
why nurses should:
1. collect data about patient care
systematically, and 2. analyze these
data statistically.
 The data that Florence nightingale
collected were important for
communicating the health status of
her patients to other nurses,
physicians, other health care
workers, and hospital management.
 In modern times, clinical data
derived from the written patient
record continue to support clinical
decision making, care management
and planning, and assessment of the
quality of care.
 Modern definition of nursing
informatics:
 Nursing informatics is the endeavor
of analyzing, formalizing and
modeling how nurses:
 collect and manage data ،
 Use data to derive information and
knowledge ،
 make knowledge-based decisions
and inferences for multidisciplinary
patient care.
 Use of this knowledge broadens the
scope and enhances the quality of
The research methods central to
nursing informatics are focused on:
1. Identification of the requirements
for computer-based systems،
2. Development of models of
information and knowledge
processing for all aspects of nursing
practice،
3. Design, implementation, and
assessment of information systems
for nursing practice, and
4. Measurement of the effects of these
systems on nursing practice and
 NURSING KNOWLEDGE:
 A nursing information system consists of
computer software and hardware, and
takes account of the people,
organizational structures, and processes
that use clinical information for nursing
care.
 The nursing process steps are:
1. Assessment
2. Diagnosis
3. Planning
4. Intervention, and
5. Care evaluation.
 Data, information, and knowledge
in nursing informatics:
 Data: Are entities that describe the
functional health status of the patient, that
have relevance for nurses
 Information: represents the clinical view of
the nurse: the interpretation of the patient
data
 Knowledge: is information that is derived by
induction, and substantiated by scientific
methods so that relationships can be
identified and verified. In nursing,
generalizations, clinical views and
interpretations comprise domain knowledge.
This knowledge, often based on clinical
 The process of nurses‟ collection and
aggregation of data into nursing clinical
information and knowledge is not different
from that for other clinicians, except that
nurses lack a uniform terminology for
expressing their more abstract
observations.

Nursing knowledge can be categorized as

follows:
 Domain knowledge: comprising facts and
relationships about nursing.
 Inferential knowledge: defining recurring
clinical reasoning steps in nursing
 Task knowledge: guiding the selection of
procedures and activities for proper task
 MULTIDISCIPLINARY
COLLABORATION:
 Most nurses work in groups on
designated shifts, and interact with a
variety of clinical colleagues.
 Therefore, support for
multidisciplinary collaboration is an
essential requirement for nursing
information systems.
 Such systems must be built in such a
way to facilitate collaboration among
a variety of health care workers
within the clinical environment.
In patient care, nurses draw on clinical
information from several disciplines:
 At the bedside: nurses record and use the
same patient data that are required and
used by the physicians .
 Yet, additional nursing data are collected
as well.
 Physicians and nurses each may transform

data into different clinical abstractions,

and then use those data to make different
diagnostic inferences, care plans, and
prognostic predictions. Thus health
workers from different clinical disciplines
THANK YOU
 lecture 8

The Patient Record

 The traditional paper-based
patient record:
Contains:
 The notes of clinicians and other care providers.
 Data from other sources: laboratory test results and reports
describing the results of other tests that have been
performed, such as X-rays, pathology, ultrasound, lung
function, and endoscopy.
 The nursing record.
Most non-textual information, especially images, can be
viewed only upon request, and it may even be necessary
for the clinician to go to a special location to view the
materials.
Hence, the set of patient data is not yet available as a whole
at the place and time it is needed.
 History of the Patient Record
 The patient record is an account of a patient‟s health and
disease after he or she has sought medical help.
 Usually, the notes in the record are made by the nurse & or
the physician.
 The record contains findings, considerations, test results
and treatment information related to the disease process.
 In the fifth century B.C., medical reporting was influenced
by Hippocrates. He advocated that the medical record serve
two goals:
 1. It should accurately reflect the course of disease, and
2. It should indicate the possible causes of disease.
 Those times, the records contained descriptions of events
that preceded disease rather than real causal clarifications.
Description of a disease by Hippocrates
2,600 years ago. The patient history is
that of Apollonius.
 Hippocrates recorded his observations in a purely chronological order. This is known
as a time-oriented medical record.
 The descriptions mainly reflect the story as it is phrased by the patient and the
patient‟s relatives.
 Until the early 19th century, physicians based their observations on what they could
hear, feel, and see.
 Shortly after 1880, the American surgeon William Mayo formed the first group
practice, which became the now well-known Mayo Clinic in Rochester, Minnesota. In
the early Mayo Clinic, every physician kept medical notes in a personal leather-bound
ledger. The ledger contained a chronological account of all patient encounters. As a
result, the notes pertaining to a single patient could be pages apart, depending on
the time intervals between visits. The scattered notes made it complicated to obtain
a good overview of the complete disease history of a patient. In addition, part of the
patient information could be present in the ledgers of other physicians.
 In 1907, the Mayo Clinic adopted one separate file for each patient. This innovation
was the origin of the patient-centered medical record.
 In 1920, the Mayo Clinic management agreed upon a minimal set of data that all
physicians were compelled to record. This set of data became more or less the
framework for the present-day medical record.
 Despite this initiative toward standardization of patient records, their written
contents were often a mixture of complaints, test results, considerations, therapy
plans, and findings.
 Such unordered notes did not provide clear insight, especially in the case of patients
who were treated for more than one complaint or disease.
 In the 1960s, Weed attempted to improve the
organization of the patient record by introducing
the problem-oriented medical record.
 In this problem-oriented medical record, each
patient was assigned one or more problems.
 Notes were recorded per problem according to
the SOAP structure, which stands for:
Subjective (S; the complaints as phrased by the
patient),
 Objective (O; the findings of physicians and
nurses),
 Assessment (A; the test results and
conclusions, such as a diagnosis),
 Plan (P: the medical plan, e.g., treatment or
policy).
 Types of formats of Written
Medical Records:
 time-oriented,
 source-oriented,
 problem-oriented
Panels 7.2, 7.3, and 7.4 provide three versions of
the same notes in time-oriented, source-oriented,
and problem-oriented formats, respectively.
 The Present-Day Medical
Record:
 Most modern patient records are not purely time
oriented, because strict chronological ordering is
difficult.
 Laboratory test results may be separated by visit
notes, X-ray reports, and other information.
 Nowadays, current records are generally source
oriented, i.e. contents of the record are ordered
according to the method by which they were
obtained; notes of visits, X-ray reports, blood
tests, and other data become separate sections in
the patient record. Within each section, those
data have a chronological order.
 Uses of the patient record:
 Include the following:
 1. Supporting patient care:
 — a source for evaluation and decision making, and
— a source of information that is shared among care providers.
 2. A legal report of medical actions.
 3. Supporting research:
 — Clinical research,
— epidemiological studies,
— assessing quality of care, and
— post marketing surveillance of drugs.
 4. Educating clinicians.
 5. Healthcare management and services:
 — providing support for billing and reimbursement,
— a basis for pre-authorization by payers,
— providing support for organizational issues, and
— providing support for cost management.
 Disadvantages of paper-based
patient records:
 Paper files can only be in one location at a time, they may
become lost or cannot be found at all.
 Handwriting may be poor and illegible.
 Data may be missing,
 Notes may be too ambiguous to allow proper interpretation.
 The Paper-based record cannot actively draw the care
provider‟s attention to abnormal laboratory values,
contraindications for drugs, or allergies of the patient, for
example, to iodine and penicillin. i.e. Paper-based notes
cannot give active reminders, warnings, or advice.
 Disadvantages related to research purposes and healthcare
planning. For scientific analysis, the contents need to be
transcribed, with potential errors.
Problems with Paper-Based
Records in Nursing:
In today‟s information-intensive health care environment, the
nursing documentation of patient care takes too much
time. Nurses often record the same data in several places
in the chart and in administrative tracking lists. This
redundancy should not be necessary, given the
capabilities of modern computers. Several weaknesses of
paper-based records in patient care have been identified
such as:
 Missing data, excessive or redundant data, and lack of
decision-making rationale,
 lack of clarity when dealing with different patient
problems over a long period of time,
 problems with the accessibility, availability, and retrieval
of individual records;
 difficulty in making changes to a record and in keeping
the record up to date,
 difficulty in evaluating patient outcome on the basis of a
poorly organized paper-based record, and
 problems reading the handwriting of health care providers
 Because of the explosive growth of clinical
knowledge, it is important that relevant
knowledge be made available at the point
of care and that information be
aggregated to allow for the examination of
quality of care and of care outcomes.
 The growth in the complexity of patient
care data runs parallel to the excessive
growth in requirements for documentation
of patient data that need to be made
available for multiple providers and for
statistical purposes.
 The Computer-based Patient
record (CPR)
 Computers have the potential to improve
understanding, accessibility, and
structure, but these pose heavy demands
on data collection.
 For more than 25 years people have tried
to develop the CPR.
 The first developments were in a hospital
setting and focused on those parts of the
patient record that were relatively easy to
structure, such as those containing
diagnoses, laboratory test results, and
medication data.
 Definition of CPR:
 The Computer-based Patient Record (CPR) is a
longitudinal electronic record of patient health
information generated by one or more encounters
in any care delivery setting. Included in this
information are patient demographics, progress
notes, problems, medications, vital signs, past
medical history, immunizations, laboratory data
and radiology reports. The CPR automates and
streamlines the clinician's workflow. The CPR has
the ability to generate a complete record of a
clinical patient encounter - as well as supporting
other care-related activities directly or indirectly
via interface - including evidence-based decision
support, quality management, and outcomes
reporting.
 An example of a form is that used in the RMIS (Regenstrief
System) shown in Fig. 7.2.
 On these forms, the system has printed part of the patient data,
such as diagnoses and problems that the patient is known to
have, medication prescribed at the previous visit, and test results
that have become available.
 In the case of a new patient, only basic administrative information
appears on the form.
 Most of the encounter forms have a number of fixed items which
the care provider is expected to fill in, such as weight, blood
pressure, pulse rate, possible new diagnoses, medication, and
medical decisions.
 The physician or the nurse can add notes pertaining to history and
physical examination in writing, if they are considered to be
relevant.
 A variety of different forms are usually available to accommodate
preferences at the level of a clinical specialty or department.
 After office hours, the contents of the
forms are entered into the computer by
clerical personnel.
 Clinicians can consult the patient record
on the computer at any time and generally
do so mainly outside office hours.
 Transcription of freehand dictations by
clerical staff has the disadvantage that
the data are not immediately available
and may contain errors as a result of
misinterpretations.
Use of CPRs in Primary Care:
 GPs are far ahead of the specialists in computerized record
keeping, and if they do, it usually involves the recording of
data in the context of research.
 Besides electronic record keeping, primary care information
systems also support the administrative and financial
aspects of running a practice.
 Usually, the CPR is an electronic version of the paper-based
patient record with options for problem-oriented record
keeping.
 The information system is usually able to print referral
letters and prescriptions, and it often provides the option to
code diagnoses and findings according to the International
Classification of Primary Care (ICPC) or the ICD9-CM.
 Specialty Care
 Explanations for the fact that specialists are not
as eager to adopt the CPR as GPs:
1. Specialists work in a complex environment,
2. CPR may be more time-consuming for a
specialist
3. Finally, there may be different specialties in a
given clinic, each with its own requirements for
the contents of the patient record
 It is unlikely that one CPR could satisfy the
majority, of specialists. System developers must
tailor the CF for a specialist in such a way that
the record can accommodate a variety of
domains, while the record‟s contents can be
merged with those of other providers to form a
complete record of the patient‟s medical history.
 Data Entry
 Reliable patient data suitable for both
patient care and decision-support and
research requires adequate data entry.
 The entry and presentation of data in the
CPR are primary topics in CPR research.
 There are two main strategies for the
collection of structured data:
1. natural language processing, and
2. direct entry of data in a structured
fashion.
1. Natural Language Processing (NLP):
 Natural language processing (NLP) has the
advantage that it can be applied to existing free
text.
 The text must be obtained by dictaphone or a
speech recognition system, but the most current
CPRs allow physicians and nurses to remain fully
free in the amount of detail that they provide and
their choice of words.
The advantage of NLP: It does not restrict the
clinician in phrasing his or her findings.
The disadvantage of NLP: It cannot stimulate
care providers to be more complete and more
explicit in their descriptions.
2. Structured Data Entry (SDE):
 Means entering the data directly in a
structured way.
Advantage: Results in more reliable and
more complete data
 This type of information must be
incorporated into the user interface in
such a way that the user needs only to
choose from available options.
 An example is the Pen&Pad interface for
SDE, as shown in Figs. 7.3 and 7.4.
 Figure 7.3. Example of a screen of the
Pen&Pad system that helps the user to select
the symptom or complaint to be described.
The list on the left
presents complaints
of a general nature.
The symptom list on
the right has a
specific focus,
depending on a
location selected by
the user, in this case
the chest.
Figure 7.4. The screen of the Pen&Pad system
offers predefined options for description after
a symptom has been selected.
 Speech Recognition for
Reporting of Medical Findings:
 An increasing number of clinicians are using a speech recognition system to
streamline the reporting process. For instance, radiologists, pathologists, and other
clinicians use it to report diagnostic imaging findings.
 Currently, most clinicians use dictation, a slow and expensive method that, due to
delays in typing pools, may require days to produce a typed report.
 Because typing errors may be introduced, the documents must be reviewed by the
clinician and mistakes must be corrected.
 With a speech recognition system linked to, for example, a radiology information
system, the physician can dictate, edit, and instantly create electronic reports. These
reports are immediately available to other clinicians and can be integrated with
electronic patient records. This leads, in principle, to a considerable saving of time,
offering a better service and reducing costs.
 A speech recognition system can usually be installed on a personal computer,
equipped with a microphone, with typically 16 to 32 megabytes of random access
memory, required to run the program. The system records the speech signal;
digitizes and processes the signal; compares the analyzed speech patterns with a
collection of possible words, deciding which of these words is most likely to have
been articulated; and finally, generates the written text.
 At present, 90 to 95% of words can be recognized correctly.
 Representation of Time:
 Time plays a very important part in health care. The patient‟s
course of disease unfolds over time, the physician‟s insight may
evolve over time, and protocol-based care involves actions with
specific intervals in between. Therefore, time stamping is
essential.
 The patient record is a chronological account of observations,
interpretations and interventions.
 The physician relies on time-related data for decision making,
such as repeating a test or renewing a prescription.
 Interpretation of data and decision making can be difficult when
time indications are inaccurate.
 Time stamps are also essential for detecting trends, for example,
in an intensive care unit or when following the condition of
chronically ill patients. For instance, when the number of white
blood cells seems to decrease, knowledge of the amount of time
between two consecutive measurements is essential.
 How can time be expressed in a Patient Medical Record?
 Time can be expressed in relative terms (“2 days after”) or in
absolute terms (“June 5th, 10:30 a.m.”).
 Relative time is used in medical knowledge that must be applied to a
particular situation and in, for example, descriptions of the course of
disease.
 Absolute time is often associated with facts, such as the date of a
visit or the date of a bone fracture.
 Why must Time stamps be recorded in the CPR in a
standardized format?
 Temporal indications are essential for the following two reasons:
1. The patient record must be a reliable reflection of reality, and
because it is not legal to edit the data in a patient‟s record at a later
date, there must be an option to record evolving insight.
2. Medical actions must always be interpreted in the proper context: a
physician may not be held responsible for improper medical actions
taken on the basis of insight that was available at a later time but
that was not available at the time that those actions were taken.
 Classic examples of data where several time stamps
are required are the laboratory tests:
1. the moment that the sample is taken,
2. the moment that the sample is tested, and
3. the moment that the test results are available to the
physician.

 A test result provides information about the sample the

time that it was taken. When too much time lapses
between sampling and testing, the result may become
invalid. It is also important that abnormal test results come
to the physician‟s attention as soon as possible.
 Clinical Use of the CPR
 Despite all of the developments regarding the
CPR during the last few decades, it is still only
used on a small scale in most settings.
 The paper- based record has five strong
advantages and the CPR has seven principal
strengths (Table 7.1).
 Apparently, most present CPR applications do not
yet outweigh the advantages of the paper-based
record. Familiarity with the current routine of
using paper- based patient records plays an
important role in this respect.
 Advantages of Paper Records. Advantages of CPRs
1. They can easily be carried around 1. Simultaneous access from multiple
2. Much freedom in reporting style, locations,
3. Easy data browsing, 2. Legibility,
4. Requires no special training, and 3. Variety of views on data,
5. Never ‘down’ as computers sometimes 4. Support of structured data entry (SDE)
are. 5. Decision support,
6. Support of other data analysis,
7. Electronic data exchange and sharing care
support
 Other Uses of the CPR
 1. in research.
 2. Assessment of quality of care.
 3. Efficient delivery of data to other
parties.
 Multimedia Patient Records
 The multimedia patient record (MPR)
is an improvement on the CPR by
adding images and signals.
 THANK YOU
 lecture 9

Nursing Informatics

Content of the Clinical Nursing

Record
 Nursing knowledge can be
categorized as follows:
Nursing knowledge in information systems are
divided into:
1. domain knowledge, comprising facts and
relationships about nursing,
2. inferential knowledge, defining recurring clinical
reasoning steps in nursing,
3. task knowledge, guiding the selection of
procedures and activities for proper task
performance, and
4. strategic knowledge, selecting alternative
nursing tasks that may be suitable for certain
situations.
 The model presented in Fig. 1
permits the study of the way that
nurses use data to derive
information.
 It also serves as a model for nursing
informatics in general;
 it is a descriptive representation of
the data-to-information flow of
clinical nursing.
The model includes the
following components:
 Data interpretation represents
decisions made in clinical practice.
 Interventions represent all the
activities following the decision
making.
 Evaluation refers to patient
outcomes that result from
interventions and includes
evaluation of the process itself.
 Deduction represents the nursing
diagnoses.
 Nursing informatics is important for
nursing as a discipline.
 It has the potential to advance
clinical nursing knowledge and
expand its scientific base. In this
way, nursing informatics can
contribute to understanding what
affects the quality of nursing care.
Thank You
 lecture 10
Health Informatics in
Primary Health Care &
Hospital departments
 I. Health Informatics in Primary
Health Care
 In primary care, a wide variety of patient
data are collected, forming a very wide
spectrum of complaints, findings,
laboratory data, prescribed drugs, reports
from specialists, etc.., covering virtually
the entire spectrum of health care.
 Furthermore, medical knowledge is
continuously expanding, and new
diagnostic methods and therapeutic
techniques become available all the time.
A primary care information system
aims to take care of:
1. Practice organization and
administration
2. Patient care
3. Statistical overviews and research
Information systems for primary care should
support the following tasks and functions:
1. collect patient data in user-friendly and
standardized ways;
2. transmit patient data electronically to other
clinicians for consultation;
3. use data for shared care and evidence-based
medicine;
4. receive alerts if deviations from guidelines or
protocols are detected;
5. receive support in decision making,

6. make communication with systems elsewhere

possible, for example, the digital library;
7. use the data for preventive purposes and case
finding;
8. be able to assess the quality and the efficacy of
care;
9. use the data to support practice management and
planning;
A primary care information system
consists of the following modules:
1. Basic module: for demographic data,
personal & family data, registration of visits,
examination and laboratory tests, simple
financial data
2. Medical module: The CPR is the heart of the
medical module. Data is grouped by visit
and time, SOAP (Subjective, Objective,
Assessment, & Plan). Diagnoses and
reasons for encounter are coded according
to ICPC.
3. Pharmacy module: for dispensing drugs.
4. Scheduling module: for appointment
registration.
5. Financial module: for producing invoices,
registering payments, and printing
reminders.
6. Communication module: to exchange
information between different care
 II. Hospital Department
Information Systems

 The majority of clinical department

information systems functions range
from pure administration and billing
to the creation of research
databases, decision support, picture
archiving, and image analysis.
Figure 12.1 sketches an overview of virtually all patient-oriented

information systems that can be found in a clinical environment.

 Computers in clinical departments are generally used for:
1. Administrative support: The administrative and
logistic planning of patient care and interventions.
2. Patient data collection: The acquisition, storage,
and retrieval of patient data, examinations,
biosignals, and images in CPRs; coding &
processing of patient data; and integration of all
patient data into one comprehensive presentation.
3. Decisions: Simulation of interventions by using
models, the support of diagnostic and therapeutic
decision making, and the offering of advice and
reminders to patients.
4. Monitoring: The monitoring and assessment of
therapy, such as drug therapy, and the monitoring
of patients in the clinic or at home.
5. Reporting: Generation of reports, discharge
summaries, or referral letters.
6. Assessment: Evaluation of the effect of the care
that was provided on patient outcome.
7. Research: Studying the course of diseases.
Examples of Use of Computer technology in Diagnosis
of Medical conditions

Eg. Endoscopy
Eg. 2. Cardiology: Coronary arteriogram:
Report of a computer processed ECG:
THANK YOU