Medical Informatics as a Discipline (Introduction to Medical Informatics) (http://www.cpmc.columbia.edu/edu/textbook) LAST REVIEWED: 8 September 1998 medical informatics = study and use of computers and information in health care purpose of this lecture is to further define the field definition by MF Collen (MEDINFO '80, Tokyo, later extended): "Medical informatics is the application of computers, communications and information technology and systems to all fields of medicine - medical care, medical education and medical research." definition by Asso. of American Medical Colleges (AAMC) 1986 "Medical informatics is a developing body of knowledge and a set of techniques concerning the organizational management of information in support of medical research, education, and patient care.... Medical informatics combines medical science with several technologies and disciplines in the information and computer sciences and provides methodologies by which these can contribute to better use of the medical knowledge base and ultimately to better medical care." analysis of definition: patient care, research, and education combination of and interface between several disciplines not just computers but information in general (eg DA) practical goal: to provide better health care origin of term: "Medical Informatics" Russian = informatika 1968 by AI Mikhailov, "Oznovy Informatika" ("Foundation of Informatics") structure and properties of scientific information French = informatique de medecine 1968 university departments established with this title English = first appeared in 1970s we changed our name from Medical Information Science origin of field: interface among disciplines initially: computer science (AI) applied to medicine later: biostatistics, DA, economics, cognitive psychology history of computers 1840s - Charles Babbage's Analytic Engine: never completed, but prompted the first computer programs (by Augusta Ada Byron) 1890 - Herman Holleriths's punch cards for census 1940s - early programmable digital computers (ENIAC) EDVAC (Von Neumann) = first stored-program computer 1943 - Aiken: electromechanical Mark I to generate math tables (program on punched tape) 1950s - commercially available (Univac) first high-level languages and compilers (coined by Hopper) LISP (McCarthy at MIT); FORTRAN 1960s - faster, more memory additional languages: ALGOL (1960) COBOL (Hopper, 1960) MUMPS (MGH, 1966): string manipulation + built-in db GEMISCH = GEneralized Medical Information System for Community Health (Hammond & Stead, Duke, 1969) 1970s - minicomputers 1980s - microcomputers, networks 1990s - RISC, workstations, growth of networks history of the discipline in the USA 1950s - building support in NAS and NIH 1960 - NIH Health Advisory Committee on Computers in Research 1964 - NIH Computer Research Study Section 1964 - 1966: "Life Sciences Computer Resources" program: Brown, Harvard, NU, Brandeis, UMass, UConn, Tufts, Utah, Washington Univ 1968 - 1974: NCHSR&D -> NCHSR HIS: PROMIS @ UVM; Lockheed system at El Camino Hospital Office Systems: COSTAR (MGH) Clinical Support Systems: MGH radiology; automated ECG interpretation Patient Monitoring Systems Consultation Systems: MYCIN (Shortliffe, Stanford); HELP (Warner, Utah) 1972 - NLM fellowship training program 1973 - SUMEX-AIM (Stanford) 1983 - IAIMS: Hopkins, Harvard, Baylor, Cincinnati, CPMC, GU, U Maryland, Utah 1989 - UMLS: Metathesaurus, Source Map, Semantic Net 1989 - AHCPR appearance of computers in medicine 1960s - practical = early departmental and monolithic research = early ECG and diagnosis 1970s - practical = monolithic administrative & departmental, imaging (CT), early bibliographic retrieval research = alerts, Mycin (early successes) 1980s - practical = results reporting, outpatient, growth of clinical systems and databases research = AI, IR 1990s - practical = integration, communication research = vocab, interfaces, coding, evaluation (note how medicine lags computer hardware) 3 phases of computer applications (Shortliffe & Greenes) vertical task: limited functions, "power users", limited audience ex: radiology or pharmacy system transition: access and communication ex: hospital information system horizontal integration & problem solving: bringing data and knowledge to bear at the point of care Computers have been slow to enter clinical care # hosp with billing, ADT vs lab, clinical, AI # offices with clinical systems but clinical care is largely the management of info. primarily in the background: practice mgmt, libraries, billing, financial factors in lack of use of computers in clinical care involves complex organisms (unlike physical processes) if over-simplify, not useful (vs bank transaction) therefore need sophisticated abstraction + detail technology for gathering complex info. just emerging eg low use of QMR or DXplain therefore providers have not entered info. reimbursement has not been linked to clinical info. therefore many admin. systems but few clinical health care administered by individuals, small groups less need for coordination inertia fear: "cookbook medicine" liability ignorance money security, integrity lack of standards language previous failures rapid turnover of technology recent increase of medical informatics not new field (eg Ledley, Lusted [active in NIH], Slack, Warner, Wigertz in the 1950s) but marked increase in popularity, funding, publication eg 1984 AAMC recommended formation of MI academic units (first done in Europe, esp France, in the 1960s) factors in recent increase of medical informatics increase in use of technology - more data generated mobility of population - need to communicate specialization - need to communicate managed care systems - need to communicate rise in health care costs - attempt to control care improved hardware - faster and more memory improved methods - acquisition, transfer, retrieval reduced computer costs increased awareness related fields: biomedical engineering - ECG, devices MI higher level of abstraction electrical engineering - hardware computer science - algorithms, closer to mathematics MI specific to health domain medical computer science - subdivision of comp sci MI more practical, includes users evaluation is critical to MI cognitive science - AI and psychology MI not concerned with studying human brain information theory - physics of communication information (library) science - manage paper/elec info MI is close to this but MI not limited to info. storage and retrieval software industry - producing products MI stresses evaulation MI not dependent on selling every product medical informatics as a science broad spectrum (theory to practice) basic science (knowledge for itself, models) experimental science (hypothesis, experiment, analysis) applied science, engineering (practical goals) composition of medical informatics groups MDs, RNs, dentists, other health care workers PhDs, esp computer science (also physics, ...) administrators, policy planners masters, PhD programs in medical informatics industry part-time vs full-time institutional organization division within medicine aspect of computer science inter-disciplinary center department (like biostatistics): relatively unusual in USA why a new discipline? often cannot get credit in related fields for work at the interface of related disciplines few were championing clinical applications MI organizations and journals organizations: AMIA (American MI Asso.), IMIA (AMIA = SCAMC 1977 + AAMSI [Am Assoc Med Sys and Inf Cong] + ACMI merged 1989) journals and proceedings: Journal of the AMIA Methods of Information in Medicine Computers and Biomedical Research Medical Decision Making SCAMC (AMIA): now Fall Symposium MEDINFO (IMIA) funding: NIH, NLM, AHCPR, (NSF), industry, foundations major academic research centers Columbia (Clayton) Stanford (Musen; Shortliffe) Harvard (Barnett, Greenes, Slack) Vanderbilt (Miller) Duke (Hammond) Indiana (McDonald) current issues in clinical care cost accessibility of health care coordinating care and setting policy acquisition and retrieval of data (eg across inst.) acquisition and sharing of knowledge (eg specialist) medical informatics research mirrors clinical issues data acquisition - GUI, nlp data storage - databases, modeling vocabularies - format, content organization of data - Larry Weed POMR 1969 machine interfaces - standards like HL7, security data retrieval - query languages knowledge acquisition knowledge representation - Arden application of knowledge when needed - decision analysis, alerts, diagnosis education care plans and practice guidelines general research questions in medical informatics knowledge extraction from db structuring knowledge: impact on acquisition, storage and retrieval linking different classes of knowledge using knowledge to make decisions human factors in computing taxonomy linking disparate systems 1998 research topics wide area networks for health care outcomes and patient satisfaction internet patient access to data clinical guidelines vocabulary data mining images speech input alerts telemedicine careers academic MI other fields: clinical, administrative, management, research operational responsibility CIO (hospital) MI industry goals of the course what is medical informatics overview of use of computers and info. in health care specific uses (applications) general methods what are the current issues capabilities and limitations of MI hands-on experience related reading: Greenes RA, Shortlife EH. Medical informatics: an emerging academic discipline and institutional priority. JAMA 1990;263(8):1114-20. Collen MF. The origins of informatics. JAMIA 1994;1:91-107. van Bemmel JH, Musen MA eds. Handbook of Medical Informatics. Heidelberg: Springer-Verlag, 1997; pp xxxi - xxxiv.