Medical Informatics Overview - Department of Internal Medicine

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Vlad Olchanski, PhD

o

Moscow Institute of Physics and


Technology

o

Institute of Control Sciences

o

International Institute for Applied


Systems Analysis

o

World Health Organization

o

Medical College of Virginia

November 7, 2002

Richmond, VA

MCV Course for 4th year medical students

Dr. Olchanski Home Page

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Medical Informatics:

Computers, Decisions, and Communications

Medical Informatics

Outline of Lecture


Informatics:

Philosophy of Governing Life



Component 1

Information Technology

Computers

Communications

Internet


Component 2

Decision Support and Theory

Medical Records

Diagnostic Support

Pharmaceutical Prescriptions

Health System Modeling

Data Mining


Overview of the subject and a couple of practical advises

Medical Informatics

INTRODUCTION

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Phi Beta Kappa

-

philosophia biou kybernetes


Philosophy Governs Life


Philosophy


Mathematics


Natural Philosophy


Physics


Engineering


General Theory of Systems


Cybernetics


Informatics


General Theory of Systems

Bertalanffy (Austria
-
Hungary), Bogdanov (Russia)
-

1908


Crash of empires after the Great War


The Second World War: FLAK

Norbert Wiener (MIT):


Cybernetics: Control and Communication in the


Animal and the Machine
-

1948


The Second World War: Enigma

Theory of Information, Finite Mathematics, Probabilities


John von Neumann (Princeton)


Alan Turing (Bletchley Park)


Claud Shannon (MIT)


Andrey Kolmogorov (Moscow State)


Cybernetics


Theory of Information

Communications

Coding

Algorithms

Probabilities and Stochastic Processes


Theory of Control

Operations Research

Optimization

Management Science


Systems Analysis

Applications


Live, bio
-
systems


Engineering, machines, robots


Organizational systems


Computer Science


Systems Analysis


Decision Support, Artificial Intelligence

Whence Informatics?



Concept of Cybernetics turned too broad


Word
Cybernetics tarnished, devalued

by
Sci
-
Fi and Pop culture


Pragmatic reduction to
Computer Science


in USA


CS translated into
INFORMATIQUE
in
France


Backward translation of
CS

as
INFORMATICS
expanding the scope

Handbook of Medical
Informatics


http://www.mieur.nl/mihandbook


http://www.mihandbook.stanford.edu/

This excellent book unfortunately

has very little coverage of the

Internet applications.


Otherwise,
this is the #1 Resource
!

Medical Informatics

Definitions


Medical Information Science is the science of
using system
-
analytic tools . . . to develop
procedures (algorithms) for management,
process control, decision making and scientific
analysis of medical knowledge
-

Ted Shortliffe


Medical Informatics comprises the theoretical and
practical aspects of information processing and
communication, based on knowledge and
experience derived from processes in medicine
and health care
-

Jan van Bemmel

Whence Informatics?


Computer Science and Informatics are
practically synonyms: the difference in
emphasizing the application aspect


Informatics is frequently understood as
broadly as Cybernetics
--

Information Processing including Decision
Making and Systems Analysis

Informatics
-

What?


Information Technology and Theory

Computers, Communications, Data
Processing, Algorithms



Decision Theory and Applications

Bayesian Approach, Expert Systems,
Artificial Intelligence, Knowledge
-
based
Systems, Algorithms

A Good INTRO to Informatics

But should we go all the way together?

Medical Informatics

INFORMATION TECHNOLOGY

COMPUTERS

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Computers: Evolution

Von Neuman and the first
MAINFRAME

at IAS (1948)

Vacuum tubes, punch cards or tape

Batch mode of operation

Low reliability
-

maintenance team of electronics engineers

Transistors

-

Bill Shockley, 1956 NP

MINICOMPUTERS

Interactive mode of operation

Higher reliability due to Transistors

MICROCOMPUTERS

Interactive mode of operation

Reduced size and enhanced

reliability due to Integrated Circuits

PERSONAL COMPUTERS

Renamed from minicomputers to show due respect

SUPERMINIS

WORKSTATIONS

SUPERCOMPUTERS

Programming Mainframe

Booting

your computer
--

giving it a kick?


No!

It is short from
bootstrapping
.



Bootstrap
” was the name of

a short length of the
punched

tape

that was fed to a

computer to initiate loading of

the
Operating System
.


Medical Informatics

INFORMATION TECHNOLOGY

COMMUNICATIONS

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Communication Protocols



Standards
-

7 layers of ISO communication protocols


from bits, wires to applications




Internet protocols


FTP, Telnet, Email, NNTP, HTTP==WWW

Communications include
-



Noise elimination in the channel



Coding (error detection and correction)



Encryption (security)



Internet

Internet Protocols


FTP (file transfer protocol) serves to
exchange data with a remote computer


Telnet allows to run programs on a
remote computer


Terms:


Upload
-

send TO a remote recipient

Download
-

receive FROM a remote sender

Remote Computing
-

I

Wilma at CUNY has data, needs report!


Fred at UBC has

report software...

Remote Computing
-

II

Wilma at CUNY has data, needs report!


Fred sends Wilma

the username

and the password

Never by EMAIL !!!

Remote Computing
-

III

Wilma uploads her data with FTP

Fred at UBC has

report software...

FTP

Remote Computing
-

IV

Wilma manipulates her data on Fred’s

computer with Telnet


Fred at UBC has

report software...

Telnet

Remote Computing
-

V

Wilma downloads the report with FTP

Fred at UBC has

report software...

FTP

Remote Computing
-

VI

Wilma prints the report in her office

and sends her kisses to Fred by email

Fred at UBC has

report software...

Email

Remote Computing
-
Security

Using Email
-

1

Email is very much like Regular Mail:

sending mail and receiving are done quite differently!


To
send mail
, you may drop a letter in
any mail drop box

in
the street.


To
send email
, you may connect and use
any SMTP server

in the world. It is for public convenience.

SMTP server sends email

Using Email
-

2

You send a letter thru a Mail Drop Box

You may use any one you find in the street

Using Email
-

3

You send an email thru a SMTP server

You may use any one you find in the Internet

Using Email
-

4

Email is very much like Regular Mail:

sending mail and receiving are done quite differently!


To
receive mail
, you must have either your own mailbox

or rent a box at any Post Office.


To
receive email
, you must have an account with any

POP3 server. It will be your private possession. You may

have as many as you may wish.

POP3 server receives email

Using Email
-

5

To receive a letter, you must have a home

or a number in a US Post Office

Using Email
-

6

To receive an email, you must have an account

at a POP or IMAP mail server

you may have as many of these as you like

Using Email
-

7

POP

server delivers all messages to your computer
--


good when you are on a fast connection


IMAP

server delivers only message headers and messages


on demand
--

good when you are on a dial
-
up


Yet you will not have all messages on your computer


Mozilla, Eudora, TheBat!

support multiple email accounts


Webmail
allows to use email with your browser
--


good when you are on the go


The poor and street people use
Hotmail, Yahoo
, etc.
--


but it is not a true email

Using Email
-

8

Basic Rules of Nice Conduct

1. Never consider email as confidential


2. Email should best be a simple message


3. Do not send messages formatted with HTML
--


not all email clients can deal with them,


it confirms a hit for spammers


(impossible not to use in AOL email program )



4. Avoid sending binary attachments


these may come corrupted and can carry


viruses

How to avoid binary attachments in Email, see


http://www.intmed.vcu.edu/inm/advice.html


The Most Intimate Secret

Like Wine dichotomy in Russia

-

White wine:



Moonshine, Vodka, Brandy


-

Red wine:


all the rest

The Most Intimate Secret

Data dichotomy in Internet

-

Text files:



Plain English text: A
-
Z, a
-
z, 0
-
9


-

Binary files:


all the rest

The Most Intimate Secret

Symbols
--

Bytes
--

Octets

Bits

Secret == 53 65 63 72 65 74

1010011 1100101 1100011 1110010 1100101 1110100

Sept “bits” fassent un “octet”!

This is the ASCII Standard.

This has been implemented in communication networks

hardware. Yet
--

Éç == C9 E7 ==
1
1001001
1
1100111

Now you see that the French have a reason to call

the “byte” not “septet” but “octet”!


If you strip the 8th bit then corruption occurs:

É
-
> 49 == I and ç
-
> 67 == g

The Most Intimate Secret

The Revelation

Only text files may be sent through Internet

Binary files will come corrupted

To send a binary, it must be converted to

a text file (encoded) and on the receiving end

the encoded file must be decoded.


In FTP protocol, the type
must

be told explicitly

In Email, binary files go as
attachments
.


There are different encode/decode procedures

which may lead to confusion and errors

Security: Cryptography

I send message to Fred

Fred reads my message

I read Fred’s answer

Dear Fred, bla
-
bla...

Dear Fred, bla
-
bla...

]hk@s#2kdMs0fHquja...

Fred’s

public

key

Fred’s private key

Dear Vlad, bla
-
bla...

Dear Vlad, bla
-
bla...

Msios$[
\
iqN7dkoZnu...

My private key

My public key

Fred answers my message

Communications. Security

80% trash, 5% pearls

Internet Protocols

Usenet, News, Forums
--

NNTP Protocol

A small ISP carries


~45,000 groups.

Different ISPs

give different groups,

have different scopes

Medical and Health

Related Groups listed:

www.mipt.vcu.edu/ng.html

Internet Protocols

World Wide Web == HTTP protocol

User client
--

browser


Opera, Mozilla, Netscape, Internet Explorer


WWW is only a small part of Internet !!!


AOL and MSN are not Internet at all !!!

Internet

AOL

MSN

gateway

gateway

Internet Services Providers give you full Internet

archive.salon.com/tech/feature/2001/06/26/locking_up_the_web/index3.html

Internet Protocols

Web Browsers

web standards are important for compatibility longevity of
websites, and future development



Opera

and
Mozilla

are W3C compliant

Internet Explorer

violates the standards
(version 6 may comply)


has many security holes

Netscape 4

is incapable to view modern websites

Netscape 7

is a commercialized version of Mozilla 1.0


Replace Netscape 4 with Opera or Mozilla!



MSN

Internet Connectivity

A decent ISP must give a client:

o

SMTP address to send email

o

POP3 address to access the mailbox

o

NNTP address to get Newsgroups


Additionally:

o

Space to host website at ISP’s IP address

o

FTP access to update website


Optionally:

o

Fixed IP address for hosting own website


Web Design

What is a good website?

--

presentable for all users: WIN, Mac, Unix, etc.

--

acceptable for all browsers: Opera, Netscape,


MSIE, etc.

--

loads fast: byte size < 50 kB

--

does not use Cutting Edge technologies


Learn the culture of Web Design at

webpagesthatsuck.com


review the Daily Sucker site daily!

Information Technology

Basics of Security



make sure workstation is physically safe and secure



never send passwords by email



never paste passwords beside the workstation



install and regularly (weekly) update virus protection



avoid sending attachments



never open unsolicited attachments, always check and


double
-
check the attachment’s file extension



never open unexpected file with extensions


EXE COM DOC DLL PIF LNK VBS


(Windows does not show LNK and PIF extensions,


you will be taken for a ride by MS )



firewall may protect both yourself and the world


but may also cheat you)

Medical Informatics

DECISION SUPPORT AND THEORY

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The Fundamental Principle
of Decision Theory

THE BAYES THOREM

[New Knowledge] = [Experimentation] x [Old Knowledge]

Application: Making Diagnosis

[Old Knowledge]

-

we know disease
D

prevalence,
p(D)

[New Knowledge]

-

we need to know if the patient has


disease
D

if he has symptom
S
,
p(D
|
S)

[Experimentation]

-

Bayes Theorem builds the Likelihood


Function:

L(D|S)

=
p(S
|
D)

/ {
p(S
|
D) p(D)

+
p(S
|
’D) p(‘D)
}


Now this Likelihood Function modifies the Old Knowledge:

p(D|S)

=
L(D|S) p(D)

Medical Decision Support

to mention a few

Clinical Systems

Financial

Medical Records

Comprehensive

Diagnostic Systems

QMR, Iliad, DXPlain, etc.

Pharmaceutical Prescriptions

Research

Data Mining

Health System Modeling

Medical Decision Support

Clinical Systems

Computerized Medical Record systems

are discussed in class:

TMR

--

CMR from Duke Medical Center

MedicaLogica



Pharmaceutical System for Multiple Drug

Therapy in ICU,
Pharm
-
X

is discussed in class



Comprehensive system for VCU HealthSystem

(by CERNER) is discussed in class.

Medical Decision Support

Diagnostic Systems

Knowledge Engineering, Expert Systems, AI

are discussed in class

observations

knowledge base

decision mechanism

diagnoses

explanations

feedback to adjust observations

Medical Decision Support

Health Systems Modeling
-

1

Primary Care Physician Supply Crisis

Medical Decision Support

Health Systems Modeling
-

2

Delays in getting the policy change bring fruits

Medical Decision Support

Health Systems Modeling
-

2

The simulation model will give a foresight

Medical Decision Support

Measurement and Statistics

Use only reasonable precision,

round up numbers to convey your purpose

Computer arithmetic is more precise

than any measurement

Medical Informatics

RECOMMENDED RESOURCE

FOR ADVANCED STUDIES

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Handbook of Medical
Informatics


http://www.mieur.nl/mihandbook


http://www.mihandbook.stanford.edu/

MCV Course for

4th year
medical

students

Education vs Vocational Training

Medical Informatics

THE END

OF PRESENTATION

MCV Course for 4th year medical
students

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