patient-centered information systems · patient-centered information systems medical informatics 1...
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Patient-Centered InformationSystems
Medical Informatics 1WS 2006/2007
Patient-Centered Information Systems
• Primary Care
• Clinical Departmental Systems
• Clinical Support Systems
• Nursing Information Systems
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Primary Care
• First-line health care (General
Practitioners)
• Medical Software
Primary Care
• Primary care information systems:developments– Evidence-Based Medicine
http://www.cochrane.de
– E.g. http://www.healthgate.at
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Clinical Departmental Systems
Clinical Departmental Systems
Computers in clinical departments
• Administrative support
• Patient data collection
• Decisions• Monitoring
• Reporting
• Assessment
• Research
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Internal Medicine
• Oncology– Oncology registration systems
– E.g. http://www.cancer.gov
– http://cgap.nci.nih.gov
• Nephrology– Monitoring dialysis
• Endocrinology– Diabetes
• Hematology– Hemophilia
Internal Medicine
• Endoscopy
• Organ Transplants– Eurotransplant (Leiden, NL); 3000 transplants per year
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Cardiology
• Electrocardiography
• Coronary angiography
• Cardiac scintigraphy
• Echocardiography
Clinical Departmental Systems
• Neurology
• Pediatrics
• Obstetrics (and gynecology)
• Surgery
• Psychiatry
• Virtual reality, augmented reality
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Clinical Departmental Systems
• Critical Care
Clinical Departmental Systems
• Critical Care– Patient Data Management Systems
• Data acquisition
• Data reduction
• Error checking
• Information display
• Decision support
• Integration (also systems outside the ICU)
• Ethical and legal aspects (auditing)
• Research
• Efficiency
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Clinical Support Systems
Medical Informatics 1WS 2006/2007
Clinical Support Departments
• Radiology
• Physiological functional laboratory
• Pathology
• Clinical Chemistry
• Pharmacy
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Radiology Information Systems
The main goal of RIS is to support both themedical and administrative functions of radiology
Imaging Systems
• Subtraction Angiography
• Computed Tomography
• Magnetic Resonance Imaging
Radiology Information Systems
Overview of tasks in a radiology information system
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Radiology Information Systems
• PACs
• Light box: better brightness
• DICOM
Function Laboratories
Examine the function of organs or organ systems (as afunction of time)
• Heart (ECG, echocardiography, scintigraphy,angiography)
• Respiratory system (spirography)
• Nervous system (EEG, EMG)
• Visual control system (EOG)
• Auditory system (audiography)
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Function Laboratories
Schematic diagram of systems operational in different
function departments
Function Laboratories
Schematic diagram of modular ECG processing
Electrocardiography
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Function Laboratories
Prior knowledge for ECG signal processing
• ECG is a quasiperiodic signal, but it may also contain stochasticcomponents (atrial flutter, fibrillation, or ventricular fibrillation)
• It has one dominant waveform, but it may also contain multiformextrasystoles
• Frequency domain between 0.15 and 150 Hz
• Disturbances (loose electrodes, 50 or 60 Hz, pacemaker pulses,EMG)
• Amplitude range: -10 mV to +10 mV
• Different application areas (diagnostic, ambulatory monitoring,screening, intensive care, research)
Function Laboratories
Report of a computer processed ECG
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Function Laboratories
Spirography
• Lung function measurements (flows, volumes,pressures)
• Respiratory gases (pCO2, pO2)
Function LaboratoriesEEG
• Stochastic signal
• Frequency analysis (FT)
• Evoked potentials
Evoked potentials in seven EEG leads resulting from stimulation by light flashes.
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Pathology Laboraty
• Diagnosis in the pathology laboratory
• The diagnostic process
• Potential sources of diagnostic errors
• The role of computers in pathology
Pathology Laboratory
Diagnosis in the pathology laboratory
• Postmortem
• Diagnosis from observations of tissue orseparate cells taken from live patients– Paraffin slice (tissue: histology, cells: cytology)
– Frozen tissue
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Pathology LaboratoryTissue/stain Reference Disagreement (%)
Bladder tumors Ooms et al. 1983 50Bone tumors Sissons 1975 ConsiderableBone marrow Morley, Blake 1975 0-56Bowel disease Dundas et al. 1987 MinorBreast cancer Stenkvist et al. 1983 23-40Cervical cancer Ringsted et al. 1978 4-58Colorectal cancer Thomas et al. 1983 31-44Endometrium Baak et al. 1981 25Gastric cancer Pagnini, Rugge 1982 4-17Hydatidiform mole Javey et al. 1979 45-66Immunostaining Muir et al. 1987 10-15Liver Garceau 1964 48Lung tumors Hansen 1982 10-considerableLymphomas Argyle et al. 1989 20-50Melanomas Larsen et al. 1980 30Muscle fiber Pool et al. 1979 40Nervous system Daumas-Duport et al. 4-19Esophagus Reid et al. 1988 13-28Ovarian tumors Stalsberg et al. 1988 25-59Soft tissue sarcoma Coindre et al. 1986 19-39Thyroid cancer Ron et al. 1986 10-15Urothelial cells Sherman et al. 1984 ConsiderableVarious Penner 1973 4-87
Disagreement Figures in Pathology Diagnoses.
aafter Baak JPA. Manual of Quantitative Pathology in Cancer Diagnosis and Prognosis. Heidelberg: Springer Verlag, 1991:14 (partly cited).
Pathology Laboratory
The diagnostic process
• Focus on certain features (extensive training)– Selection of relevant features
– Comparison with reference knowledge
– Verbal expression
– Diagnostic classification
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Pathology Laboratory
Potential sources of diagnostic errors
• Context (e.g. parathyroid tissue)
• Optical effects
• Random errors
• Systematic influences
Pathology Laboratory
The role of computers in pathology
• Education (electronic textbooks)
• Research
• Making observations objective (morphometry,cytometry)
Number of mitosesSize and shape of nucleiSize and relative position of nucleoliChromatin patternDNA content and ploidyNucleus/cytoplasma ratioSurface measurementsAbsorption of chemical markers
Examples of Parameters in Cytometry
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Clinical Chemistry and Hematology
• Confirm a suspected diagnosis
• Monitor the effects of treatment
• Exclude or screen for the presence of disease
• Assess the prognosis once a diagnosis hasbeen made
Clinical Chemistry and Hematology
Schematic representation of subsystems operational in clinical chemistry
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Clinical Chemistry and Hematology
Schematic representation of tasks performed by a laboratory
information system during a test request cycle
Clinical Chemistry and Hematology
• Request processing
• Sample processing
• The preanalytical phase
• The analytical process
• Reporting
• Management information
• Electronic reporting of clinical laboratory test results
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Clinical Chemistry and Hematology
• Request processing– Mark-sense forms
• Sample preprocessing– Bar code
Clinical Chemistry and Hematology
• The preanalytical phase
• The analytical process
The process of first-line authorization in clinical chemistry
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Clinical Chemistry and Hematology
• Reporting
• Management information– GLP
• Electronic reporting of clinical laboratory test results– Health Level 7 (HL-7) standard http://hl7.org
– Euclides (European Clinical Laboratory Information DataExchange Standard)
• LIMS (http://www.lims.de )
Hospital Pharmacy
Care-related activities
• Keeping records of medication of patients
• Checking prescriptions
• Provide information concerning prescription of drugs andadministration
Logistic activitites
• Purchasing drugs
• Keeping stock
• Manufacturing drugs
• Distributing drugs
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Hospital Pharmacy
• Processes in hospital pharmacy
• Computer applications in the hospital pharmacy– Level 1: electronic communication
– Level 2: supporting logistics (stocks etc ...)
– Level 3: computation of drugs and optimal stock parameters
– Level 5: pharmacokinetic models, knowledge base
Hospital Pharmacy
• Basic functionality
Schematic overview of a task in a hospital pharmacy system