Medical Data and Imaging Informatics

Medical Data

• Medical data records information regarding a person's health status and medical treatment
• Medical data can be recorded on paper or digitally
• It is collected and stored in hospitals and clinics, but can be communicated to public health authorities

Medical Imaging Informatics

• Medical Informatic's purpose is to collect, analyze, store, and communicate patient data
• The information is used to provide appropriate care, ensure well-being, and support education and research
• The evolution of informatics has addressed the uncertainty associated with data handling, by converting analogue data into digital format
• This has created an authoritative source for demographics and record, through the implementation of digital databases

Ontologies - ICD

• In the United States, ICD-10-CM and ICD-10-PCS are the variant manuals for coding diagnoses and procedures
• ICD-10-CM contains over 69,000 diagnosis codes and ICD-10-PCS contains over 70,000 procedure codes
• The ICD-10 content is used for
  • categorizing conditions and diseases
  • forming the foundation for healthcare decision-making and statistical analysis
  • billing for services performed in hospital inpatient settings

Ontologies - CPT

• The Current Procedural Terminology (CPT) is a medical code manual published by the American Medical Association
• CPT is used to describe procedures performed on patients, including diagnostics, laboratory, radiology, and surgical procedures
• Physicians use these codes to bill for services performed in hospital, office, or other service settings

Ontologies - RadLex

• RadLex (Radiology Lexicon) is a radiology specific lexicon of terms developed by the Radiological Society of North America
• It contains vocabulary related to anatomy, procedures, and protocols used in medical imaging diagnosis
• RadLex Playbook assigns RPID (RadLex Playbook Identifier) tags to the terms

Standards Organizations

• Medical imaging informatics rely on standards developed through consensus between key stakeholders
• These stakeholders include medical imaging equipment manufacturers, medical data software manufacturers, professional societies, and end users
• Standards define communications protocols, structures, and formats to ensure interoperability and communication between healthcare systems

Standards Organizations - Internet Standards

• The Internet protocol suite (TCP/IP) is used to connect devices worldwide
• The Internet Engineering Task Force (IETF) is responsible for developing hardware, protocol, and software standards
• Important message types for PACS include:
  • ORU - Results
  • ORM - Orders
  • ADT - Admission, Discharge, and Transfer
• Important segment types include:
  • OBR - Observation Request
  • OBX - Observation/Result

Standards Organization - HL7

• HL7 is a less formally structured standard (compared to DICOM), which allows flexibility but requires redefining implementations
• A significant amount of effort in healthcare is devoted to developing and maintaining HL7 interfaces
• HL7 is being updated to a more general model of interoperability

Standards Organization - HL7

• Fast Health Interoperability Resources (FHIR) is a new standard in the HL7 community
• It is based on web services and RESTful interfaces, using APIs and open standard file formats like XML or JSON
• FHIR can meet the needs of previous HL7 standards and provides benefits in interoperability, interfaces, and access to data

Computers and Networking

• Computer hardware refers to the physical components of a computer such as the power supply, cooling fans, and motherboard
• A PACS includes a digital archive to store images, display workstations for viewing images, and a computer network for transferring data
• A database program tracks image locations, and software allows for manipulation of images for interpretation by radiologists and referring physicians

Picture Archiving and Communication System

• Image display is a key component of the PACS
• Interpretation workstations for large matrix images are commonly equipped with two high-luminance displays for image comparison
• A consumer-grade display provides access to the RIS database, patient information, reading worklist, dictation system, EHR, and the internet

Picture Archiving and Communication System

• Computer networks enable the exchange of images and related information between imaging devices, the PACS, display workstations, and other information systems
• A PACS may have its own LAN or share a medical center LAN
• Bandwidth requirements depend on the imaging modalities and their workloads

Internet Standards

• HyperText Transfer Protocol (HTTP) is the foundation of data communication for the World Wide Web.
• HyperText Markup Language (HTML) is the standard markup language for web documents displayed by web browsers.
• Uniform Resource Locator (URL) is the standard for specifying and accessing resources on the internet.
• Network Time Protocol (NTP) synchronizes clocks in computer systems for accurate timestamping of events.
• Simple Mail Transfer Protocol (SMTP) and Internet Message Access Protocol (IMAP) are protocols used for email transactions.
• Multipurpose Internet Message Extensions (MIME) protocol extends email to include non-textual content, including medical images.
• Transport Layer Security (TLS) and its predecessor Secure Sockets Layer (SSL) secure internet transactions with cryptography.
• Syslog Protocol is used to convey event notifications for auditing and logging purposes.
• Extensible Markup Language (XML) is a free, open standard for encoding structured data, used in many new standards for distributed systems.

Servers

• A file server is a computer with a large array of magnetic disks that acts as a storage device for other computers on a network.
• There are various types of servers for different functions, such as print servers, application servers, database servers, email servers, web servers, and cloud servers.
• Most servers are now implemented in a virtual machine (VM) environment, emulating a physical computer but in a centralized location.
• Virtual Machines (VM) allow for flexibility in resource allocation and can support multiple operating systems, CPUs, and storage space within a single server.
• A cloud server is a virtual server hosted and delivered through a cloud computing platform like Google's Gmail for email services or Dropbox for cloud storage.
• Configure a cloud server for a PACS (Picture Archiving and Communication System) to handle various image management tasks, such as data extraction, DICOM conversion, image rendering, storage, and load balancing.
• Clients are computers within a network that utilize a server for various functions.
• Thick clients rely heavily on client computer processing, while servers primarily store data.
• Thin clients rely on servers for most information processing while the client mainly displays data.
• An example of a thin client is a server processing the rendering of volumetric images from CT scans and sending them to a workstation for display.
• Thin clients can utilize less powerful and less expensive workstations, with specialized software and hardware hosted on a single server for various tasks.

Cloud Computing

• Cloud computing utilizes a network of remote servers and software hosted on the internet to deliver services.
• Cloud storage services like Dropbox offer remote storage and backup capabilities for local data.
• Medical imaging software vendors are utilizing cloud computing to provide client services and databases over the internet, with storage and archiving provided by the cloud provider.

Active Directory

• Lightweight Directory Access Protocol (LDAP) is an open protocol used for accessing and managing directory information services over an IP network.
• Active Directory is a directory service developed by Microsoft that is included in Windows Server OS and utilizes LDAP for authentication, authorization, and security policy enforcement.
• A server running Active Directory Domain Service (AD DS) authenticates and authorizes users and computers on a domain network and enforces security policies.

Internet of Things (IoT)

• Internet of Things (IoT) encompasses devices connected to the internet with unique identifiers (UIDs) that collect and share data about their environment and usage.
• IoT devices range from self-driving cars to home light switches and medical devices.
• IoT applications in healthcare include remote monitoring, smart sensors, and integration of medical devices in diverse departments.
• Interoperability is crucial for effective patient care in IoT, but presents security challenges and data privacy concerns.
• Maintaining security patches and updates on IoT devices is critical for patient health and safety, especially devices outside a hospital network.

Picture Archiving and Communication System (PACS)

• A PACS is a system that incorporates software, interfaces, workstations, and databases to store, transfer, and display medical images.
• Image compression can be irreversible, where some information is lost, or reversible, where no information is lost.
• Irreversible compression allows for higher compression ratios, up to 30:1, with minimal image quality loss.
• Archives are locations for storing records and documents of historical importance.
• PACS archives store medical images in DICOM format on disks and tapes for long-term storage.
• Vendor-Neutral Archive (VNA) is a repository for various data types, including DICOM and non-DICOM images, non-image data, and other content, within an enterprise storage environment.
• Data and images are typically archived in a compressed format for efficient storage and data transmission.

ICD-10

• ICD-10-CM, the US version, is a clinical modification with over 69,000 codes for diagnoses.
• ICD-10-PCS has over 70,000 procedure codes for inpatient procedures.
• ICD-10 content is used for:
  • Assigning codes for procedures, services, conditions, and diagnoses
  • Categorizing conditions and diseases
  • Forming the foundation for healthcare decision-making and statistical analysis
  • Billing for inpatient services

CPT

• CPT is a medical code manual published by the American Medical Association.
• It describes procedures performed on patients during the interaction, including diagnostic, laboratory, radiology, and surgical procedures.
• Physicians bill and are paid based on these codes.
• Human coding teams or automated software tools verify and validate codes for specific procedures and reimbursement.
• CPT codes are more complex than ICD codes and get updated yearly.

RadLex

• RadLex (Radiology Lexicon) provides a radiology-specific set of terms created by RSNA since 2005.
• RadLex is used to describe anatomy, procedures, and protocols utilized in medical image diagnosis.
• RadLex Playbook assigns RPID (RadLex Playbook IDentifier) tags to those terms.
• RadLex is widely adopted in radiology, including the ACR Dose Index Registry.

LOINC

• LOINC (Logical Observation Identifiers Names and Codes) is a broader standard covering tests and measurements in many medical domains.
• It was initiated by the Regenstrief Institute, a medical research organization associated with Indiana University.
• LOINC is being harmonized with RadLex to use LOINC codes as the primary identifiers for radiology procedures.
• A unified vocabulary standard will improve accessibility of radiology procedure data to clinicians.

DICOM

• DICOM is a set of standards-based protocols for exchanging and storing medical imaging data, including images and associated text.
• Managed by the Medical and Imaging Technical Alliance (MITA), a division of NEMA.
• It is a public standard and information for DICOM-based software applications is defined and regulated by public committees.
• DICOM is crucial for interoperability and communication of medical imaging data between systems and databases.

HL7

• HL7 is a set of international standards governing the exchange, integration, sharing, and retrieval of electronic health information.
• HL7 International, an ANSI-accredited organization, develops these standards.
• The goal is to create coherent, extensible standards for exchanging structured, encoded healthcare information between applications.
• Version 2 (V2.8.2) is most commonly used in health systems.
• HL7 is a critical standard for automated textual information exchange in healthcare IT.

Computers and Networking

• Software programs consist of sequences of instructions executed by a computer.
• Software is categorized as application programs or system software.
• Applications are programs that perform specific functions for a user.
• Computer networks allow information transfer, enabling services like email, file transfer, and access to distant computers.
• LANs connect computers within a department, building, and occasionally nearby buildings.
• WANs connect computers over long distances.
• The Internet is the largest WAN.

Servers

• A server provides a service to other computers on a network.
• A file server provides data storage for other computers with large magnetic disk arrays.
• Servers can include print servers, application servers, database servers, email servers, web servers, and cloud servers.
• Most servers are now “virtual machines” (VMs) based on a centralized physical computer architecture.
• VMs can provide multiple operating systems, CPUs, storage space, and meet enterprise specific needs, offering flexibility, efficiency, and adaptability for resource allocation.

Cloud Servers

• Cloud servers are virtual servers running in a cloud computing environment.
• Accessed via the Internet remotely.
• They require several component servers for various tasks, including:
  • Data extraction
  • DICOM conversion
  • Image rendering
  • Storage
  • Load balancing

Clients

• A client is a computer on a network that utilizes a server.
• Typically a workstation.
• “Thick client” means the client computer handles most information processing, while the server primarily stores information.
• “Thin client” describes the situation where the server handles most of the information processing, and the client mainly displays the information.

This quiz explores key concepts in medical data management and imaging informatics. It covers the significance of health records, the transition from analogue to digital data, and the role of coding manuals like ICD-10. Test your understanding of how these elements contribute to patient care and public health.