BIOMEDICAL INFORMATICS

Invited lecturer Tinatin Churadze (PhDs)

JSC EVEX Regulatory Risk Analyst
Ministry of Health, Labour and Social Affairs
Former Senior Specialist
 Distribution of Hours
 
Lecture 14 hr.
Group Work 19 hr.
Mid-term exam 1 hr.
Final Exam 2 hr.
Total Contact hours 36 hr.
Independent work 54 hr.
 Aim of the Course
The aim of the course is to teach the student the standards of
medical informatics so that the student can retrieve, store and
implement medical data, produce clinical records correctly and
use information technology effectively while adhering to ethics.

Learning Outcomes
Student:
 Defines the fundamental principles of medical informatics.
 Lists both integrated medical information systems and patient-
centered electronic services.
 Produces and maintains personal and clinical records using
information technology in accordance with ethical standards.
 Negative Assessment
Positive Assessment

(A) Excellent – 91% and more from

maximum evaluation (FX) (Administrative Fail in Course for
(B) very good – 81-90% from Grade/could not pass)– A student gets 41-50%
maximum evaluation from maximum evaluation which means that
(C) good – 71-80% from maximum s/he is required to work more for passing the
evaluation exam, and that s/he is entitled to take a makeup
(D) satisfactory – 61-70% from exam only once through personal study
maximum evaluation
(E) sufficient – 51-60% from (F) (Academic Fail) – A student gets 40% and less
maximum evaluation from maximum evaluation which means that the
work done by him/her is not sufficient and s/he
has to retake the course.
1. The Computer Meets Medicine and
Biology: Emergence of a Discipline

2. Biomedical Data: Their

Acquisition, Storage, and Use.
 Integrated Information Management:
Technology’s Promise

After scientists had developed the first

digital computers in the 1940s, society
was told that these new machines would
soon be serving routinely as memory
devices, assisting with calculations and
with information retrieval. Within the
next decade,physicians and other health
workers had begun to hear about the
dramatic effects that such technology
would have on medical practice.
 What might that future hold for the typical practicing
clinician?

No clinical computing topic is gaining more

attention currently than is the issue of electronic
health records (EHRs). Health care organizations
are finding that they do not have systems in place
that allow them to answer questions that are
crucially important for strategic planning and for
their better understanding of how they compare
with other provider groups in their local or
regional competitive environment. In the past,
administrative and financial data were the major
elements required for such planning, but
comprehensive clinical data are now also
important for institutional self-analysis and
strategic planning.
 Many health care institutions are seeking to develop integrated clinical workstations.

These are single-entry points into a medical world

in which computational tools assist not only
clinical matters but also administrative and
financial topics (e.g., tracking of patients within
the hospital, managing materials and research,
scholarly information, and even office automation
(e.g., providing access to spreadsheets, word
processors). The key idea, however, is that at the
heart of the evolving clinical workstation lies the
medical record in a new incarnation:
• electronic,
• accessible,
• confidential,
• secure,
• acceptable to clinicians and patients, and
• integrated with other types of nonpatient-
specific information.
 Moving Beyond the Paper Record

The traditional paper-based medical record is now recognized as woefully

inadequate for meeting the needs of modern medicine. Today the
inability of paper charts to serve the best interests of the patient, the
clinician, and the health system has become clear. Most organizations
have found it challenging (and expensive) to move to a paperless,
electronic clinical record.
One argument that warrants emphasis is the importance of the EHR in
supporting clinical trials —experiments in which data from specific patient
interactions are pooled and analyzed in order to learn about the safety and
efficacy of new treatments or tests and to gain insight into disease processes
that are not otherwise well understood.
The use of EHRs has offered many advantages to those carrying out clinical
research. It helps to:
• eliminate the manual task of extracting data/filling out charts
• The data needed for a study can often be derived directly from the EHR
• to ensure compliance with a research protocol
 There is increasing importance of standard order sets, clinical
guidelines and clinical pathways

• to reduce practice variability

• to develop consensus approaches to recurring management problems.
Computer-based tools for implementing such guidelines, and integrating
them with the EHR, present a means for making high-quality advice
available in the routine clinical setting.
 There are at least four major issues that have consistently
constrained efforts to build effective EHRs:

• the need for standards in the area of clinical terminology;

• concerns regarding data privacy, confidentiality, and security;
• challenges in data entry by physicians;
• difficulties associated with the integration of record systems with other
information resources in the health care setting.
 Definition of Biomedical Informatics

Biomedical informatics ( BMI ) is the interdisciplinary field that studies

and pursues the effective uses of biomedical data , information , and
knowledge for scientific inquiry , problem solving , and decision making ,
driven by efforts to improve human health.
Scope and breadth of discipline : BMI investigates and supports reasoning,
modeling, simulation, experimentation, and translation across the
spectrum from molecules to individuals and to populations, from
biological to social systems, bridging basic and clinical research and
practice and the health care enterprise.
Theory and methodology : BMI develops, studies, and applies theories, methods, and
processes for the generation, storage, retrieval, use, management, and sharing of
biomedical data, information, and knowledge.
Technological approach : BMI builds on and contributes to computer, telecommunication,
and information sciences and technologies, emphasizing their application in biomedicine.
Human and social context : BMI, recognizing that people are the ultimate users of
biomedical information, draws upon the social and behavioral sciences to inform the
design and evaluation of technical solutions, policies, and the evolution of economic,
ethical, social, educational, and organizational systems.
 What Are Clinical Data?

• clinical datum may be any single observation of a patient—e.g., a

temperature reading, a red blood cell count, a past history of rubella, or
a blood pressure reading.
• clinical data are multiple observations.
 What Are the Types of Clinical Data?

• Narrative, textual data;

• Numerical measurements;
• Genetic information;
• Recorded signals;
• Drawings;
• Photographs or other images.
 Who Collects the Data?

• Health care team data collection and recording are a central part of its task.
• key players are physicians – they decide what additional data to collect by
ordering laboratory or radiologic studies and by observing the patient’s
response to therapeutic interventions
• Nurses play a central role in making observations and recording them for
future reference
• Office staff
• Admissions personnel
 Health data are recorded for a variety of purposes.

Clinical data may be needed to support the proper care of the patient from whom they
were obtained, but they also may contribute to the good of society through the
aggregation and analysis of data regarding populations of individuals.

Traditional data-recording techniques and a paper record may have worked reasonably
well when care was given by a single physician over the life of a patient. However, given
the increased complexity of modern health care, the broadly trained team of individuals
who are involved in a patient’s care, and the need for multiple providers to access a
patient’s data and to communicate effectively with one another, the paper record no
longer adequately supports optimal care of individual patients.

Traditional paper-based data- recording techniques have made clinical research across
populations of patients extremely cumbersome.
 Create the Basis for the Historical Record

Medical records are intended to provide a detailed compilation of information about individual patients:
• What is the patient’s history (development of a current illness; other diseases that coexist or have
resolved; pertinent family, social, and demographic information)?
• What symptoms has the patient reported? When did they begin, what has seemed to aggravate them,
and what has provided relief?
• What physical signs have been noted on examination?
• How have signs and symptoms changed over time?
• What laboratory results have been, or are now, available?
• What radiologic and other special studies have been performed?
• What medications are being taken and are there any allergies?
• What other interventions have been undertaken?
• What is the reasoning behind the management decisions?
 Each new patient problem and its management can be viewed as a
therapeutic experiment, inherently confounded by uncertainty, with
the goal of answering three questions when the experiment is over:

1. What was the nature of the disease or symptom?

2. What was the treatment decision?
3. What was the outcome of that treatment?

Data obtained from such therapeutic experiment, will give the access to
new methodologies of diagnostic processes and treatment.
 Electronic health records and computer based medical records have very important influence on
clinical research.
During clinical research massive information is created and it is also important to retrieve particular
information for specific reasons. Lets get to know types of clinical research and its terminology:

• Retrospective chart review to investigate a question that was not a subject of study at the time
the data were collected
• Prospective studies in which the clinical hypothesis is known in advance and the research
protocol is designed specifically to collect future data that are relevant to the question under
consideration. Subjects are assigned randomly to different study groups to help prevent
researchers—who are bound to be biased. For the same reason, to the extent possible, the
studies are double blind ; i.e., neither the researchers nor the subjects know which treatment is
being administered.
Using HER makes it easy to work with an immense amount of medical information, analyzing
process is more effective and smart and reduces labourative work, which is related to paper based
medical records.
Archive – special room to store medical documentation
for predefined period (In Georgia storage period is regulated by legislation)
 Because of the needs to know about health trends for populations and to recognize
epidemics in their early stages, there are various health-reporting requirements for hospitals
(as well as other public organizations) and practitioners.

Another kind of reporting involves the coding of all discharge diagnoses for
hospitalized patients, plus coding of certain procedures (e.g., type of surgery) that were
performed during the hospital stay. Such codes are reported to state and federal health-
planning and analysis agencies and also are used internally at the institution for case-mix
analysis (determining the relative frequencies of various disorders in the hospitalized
population and the average length of stay for each disease category) and for research. For
such data to be useful, the codes must be well defined as well as uniformly applied and
accepted.
 Aforementioned reporting system is actual in Georgia, where hospitals are required
to report to the Ministry of Health about the intervention that was performed during
hospital stay.

Coding system used to this purpose includes ICD-10 (The 10th revision of the
International classification of diseases) and NCSP (Nordic classification of surgical
procedures).
 The Hypothetico-Deductive Approach

Studies of clinical decision makers have shown that strategies for data
collection and interpretation may be imbedded in an iterative process
known as the hypothetico - deductive approach. As medical students learn
this process, their data collection becomes more focused and efficient, and
their medical records become more compact.
• data collection
• data interpretation
• the generation of hypotheses
After assuming the hypothesis, the doctor will determine the necessary
studies and data to help him clarify the disease. To do this, he uses
instrumental and laboratory studies, collects anamnesis. Most
instrumental studies are costly and also for patients with certain risks, so
some physicians prefer to start treatment in case of uncertain diagnosis.
Such a decision is often the subject of debate by his colleagues.
 Summery

HER and computer-based patient records (CPR), as well as

implementation and integration of computer applications in modern
everyday medical activity, makes it easy for physicians to reach pertinent
information about patient, create safe environment for medical activity
(because well done medical records protects medical personnel), makes
medical services cost-effective, timely, and high quality.
Thanks for attention and attendance!