Medical Informatics PDF

Lecture 1: Introduction of Health Informatics Data: any facts, texts, graphics, images, sounds, without meaningful relation to anything else Information: data placed in context with analysis *Information + organized data (data + meaning) Knowledge: the application of information using rules / inf...

Lecture 1: Introduction of Health Informatics Data: any facts, texts, graphics, images, sounds, without meaningful relation to anything else Information: data placed in context with analysis *Information + organized data (data + meaning) Knowledge: the application of information using rules / information that has been organised Informatics: first used in 1957, was coined as an amalgamation of ‘information’ and ‘automatic’ to describe the automatic processing of information Health Informatics: It is a specialization aspect of informatics that connects information science, computer science and health care / concerned with using computers and communication technology to acquire, store, analyse, communicate, and display medical information and knowledge to facilitate understanding and improve the accuracy, and reliability of decision-making / intersection of information science, computer science, and health care. It deals with the resources, devices, and methods required to optimize the acquisition, storage, retrieval, and use of information in health and biomedicine Medical Informatics: refers to the branch of clinical informatics that deals with disease diagnosis and management, with an emphasis on physicians / also called health informatics, healthcare informatics, nursing informatics, clinical informatics, or biomedical informatics / ‘Medical’ implies a specific clinical focus and the involvement of clinicians/doctors, while ‘Health’ in other areas implies greater generality and the involvement of other health professions Artificial Intelligence: ‘intelligent machines’ which can solve problems, make / suggest decisions and perform tasks that have traditionally required humans to solve Machine Learning: a subset of AI algorithms which learn without being explicitly programmed with rules; use data to learn and match patterns Deep Learning / Neural Nets: a subset of machine learning uses a deep neural network (DNN) effective at a variety of tasks eHealth (consumer HI): use of information and communication technology (ICT) for health / cost effective and secure use of information and communication technologies in support of health and health-related fields including healthcare, surveillance, education, knowledge, and research Telemedicine: provision of healthcare when participants separated by time and/or distance Telehealth: pursuit of health when separated by time and/or distance mHealth: use of mobile devices for health Digital Health: broad term for IT-related aspects of health and healthcare Data Information Raw facts that have no specific meaning Refers to processed data that has a purpose and meaning Derived from Latin word ‘datum’ meaning Derived from Latin word ‘informatio’ meaning something that is given formation or conception Independent of information Dependent on data  Raw data is not enough to decide Sufficient to help decide in the respective content Data Raw facts Information Processed data with contextual meaning Tells us ‘who’ ‘what’ ‘where’ ‘when’ Knowledge Collective information gained through individual expertise Describes ‘how’ Wisdom Knowledge that has an evaluative component Describes ‘why’ Data, Information, Knowledge, and Wisdom Cycle Informatics *concerned with: How data is collected and stored How it is organised How it is retrieved and transmitted Can also include issues as data security, storage, limitations, and so forth Impact of Informatics in Health ✓ Approximately 30% of the world's data is generated by the healthcare industry, which is expected to rise to 36% by 2025. ✓ The ability to effectively analyse and deploy this data is critical to the successful operation of healthcare organizations. To create the HI, you need to; i. Construct computer health information systems by studying the needs of doctors, nurses, patients, and health care organization ii. Create health networks that allow doctors and nurses to share knowledge and best practices iii. Create new methods of information delivery that motivate patients to follow treatment recommendations Health Informatics *focuses on applying information technology (IT) to the field of medicine to improve healthcare delivery, education decisions, health, and research *Medical Informatics System Components Health Informatics vs. Health Information Technology Health Information Technology (HIT): professionals build and maintain the infrastructure that makes informatics possible. Health Informatics (HI): utilizes the available data, organize and evaluate data related to patient care. HI does so with the help of HIT directly. Is Health Informatics the same as Medical Records keeping (health information management)? Health informatics: professionals (informatician) deal with all kinds of information—patient data, diagnostic data, medical imaging data, data generated by clinical trials and public health data. Medical records: specialists deal with just one type of health care data: patient records. HI, HIT, and HIM History of Medical Bioinformatics - In 1949, a German physician named Gustav Wagner founded the German Society for Medical Documentation, Computer Science and Statistics, the world’s first professional informatic organization. - In the 1960s, Germany, Belgium, France, and the Netherlands pioneered specialized university departments and informatics training programs. - In the 1970s, the United States and Poland revolutionized medical informatics research. Subsequently, high-calibre research in Health Informatics, education, and infrastructure has been one of the top priorities in implementing health programs. The American Society for Testing and Materials (ASTM) established the first standards in healthcare data reportingincluding electronic healthcare system properties, laboratory data exchange, message exchange, health information security system, and data content. Data reporting is the process of collecting and submitting data which gives rise to accurate analyses of the facts on the ground; Inaccurate data reporting can lead to decisions without enough information and dependence on incorrect evidence. Healthcare informatics has dramatically improved over the years. Today, pharmacy informatics and imaging informatics are two unique specialty studies under Health Informatics. Reorganizing - Big technological ideas and achievements discovered. and Pioneering from 1950-1975: - Laying the foundation of the “new emerging information technology” and various applications concerning IT in healthcare and medicine. Childhood and Youth (1975 - Build upon the work and achievements resulting from the - 1990) previous period - Use of computer applications are inevitable. - The establishment of the first national and international alliances with bioinformatics courses and schools is followed by the foundation of specific conferences. - “Electronic Health/Medical Record” EHR -shaped that period and the development of the generalization of Clinical and Hospital Information Systems (HIS) accompanied by medical data analysis and protection. Consolidation period (1990 - Several specialized medical/health bioinformatics schools – 2000) have been created. - Governments created national strategies for implementing medical bioinformatics in their states. 2000 - There was a lack of success in this field, and support by the – 2010 governments, because of politics, made it hard time to continue the research. Therefore, cooperation between the European countries and the USA was made to keep the research, which was successful. *Some believe it is more likely to rethink them  Strategies, because of the new trends in today's world in the form of how people share information, the large amount of data available, and more people using this data Key Players in Medical Information System (MIS) 1. Patient 2. Clinician 3. Hospitals 4. Medical educators 5. Governments 6. Public health 7. Research Patients Online searches for health information. Web portals for storing personal medical information, making appointments, checking lab results, e-visits, etc. Research the choice of physician, hospital, or insurance plan. Online patient surveys Online chat, blogs, podcasts, support groups, and social networking. Personal health records. Limited access to electronic health records. Telemedicine and home telemonitoring Clinicians Online searches with MEDLINE, Google, and other search engines Online resources and digital libraries Patient web portals, secure e-mail and e-visits Physician web portals Clinical decision support, e.g. reminders and alerts Electronic health records (EHRs) Personal Digital Assistants (PDAs) and smartphones loaded with medical software Telemedicine and tele homecare Voice recognition software Online continuing medical education (CME) Electronic (e)-prescribing. Disease management and registries Picture archiving and communication systems (PACS) Pay for performance E-research. Nursing and Support Patient enrolment Staff Electronic appointments Electronic billing process EHRs Tele-homecare monitoring. Secure patient-office e-mail communication.  Electronic medication administration record (e-Mar). Online educational resources and CME Disease registries. Public Health Incident reports Establish links to all public health departments (Public Health Information Network) ( national as in national surveillance systems or international) Geographic information systems to link disease outbreaks with geography Telemedicine Remote reporting using mobile technology. Government Nationwide Health Information Network Financial support for EHR adoption Information technology pilot projects Disease management Pay for performance Electronic health records and personal health records Electronic prescribing Telemedicine Health Information Organizations Medical Educators Online medical resources for clinicians, patients and staff Online CME MEDLINE searches Video teleconferencing, web conferencing, podcasts, etc. Insurance Information systems for “pay for performance” Companies Monitor adherence to clinical guidelines Monitor adherence to preferred formularies Promote claims-based personal health records and information exchanges. Reduce litigation by improving patient safety through fewer medication errors Hospitals Interoperable electronic health records. Electronic billing Information systems to monitor outcomes, length of stay, disease management, etc. Bar coding and radio frequency identification (RFID) to track patients and medications. Wireless technology Patient and physician portals E-prescribing Health Information Organizations (HIOs) Telemedicine Research Database creation to study populations, genetics and disease states National Institute of Health Electronic case report forms (eCRFs) Software for statistical analysis of data e.g. SPSS Literature searches with multiple search engines Improved subject recruitment using EHRs and e-mail. Sub-areas of Informatics Artificial Intelligence Decision Support Systems *Machine learning methods are used for medical data mining and language processing and can be used for automatic structuring of the information (diseases, treatments) contained in hospitals and surgical reports. Networks Computer networks support data exchange, provide easy access to large volumes of data, so increase patient management. *However, the use of networks generates specific problems in medicine related to the standardization of content in terms of the semantics of messages, data security, privacy, and the need to respect the rights of patients. Health care Information Systems It is the mechanism for collecting, processing, analysing, and transmitting information required for organizing and operating health services, research, and training. *Aimed to share data between all health care system participants, lower costs, reduce errors and improve patient satisfaction. Objectives: provide reliable, relevant, up-to-date, adequate, timely, and reasonably complete information for health managers at all levels. share the technical and scientific information by all health personnel participating in the health services of a country; provide at periodic intervals, data that will show the general performance of the health services and assist planners in studying their current functioning and trends in demand and workload Components: Demography and vital events; Environmental health statistics; Health status: mortality, morbidity, disability, and quality of life; Health resources: facilities, beds, manpower; Utilization and non-utilization of health services: attendance, admissions, waiting lists; Indices of outcome of medical care; and Financial statistics (cost, expenditure) related to the objective. Computer Aided Diagnosis o The main aim of Computer Aided Diagnosis (CAD) is to assist healthcare professionals in providing an accurate, cost-effective diagnosis within the shortest time possible. o CAD systems are used as a decision support to the clinicians. Computer-aided a diagnosis made by a radiologist who uses the output of a computer analysis diagnosis of the images when making his/her interpretation Computer-aided Used with "Screening Radiology“. detection Identify and mark suspicious areas in an image. The goal of CADe is to help radiologists avoid missing a cancer. Computer-aided Used with "Clinical Radiology“ diagnosis CADx helps radiologists decide if a woman should have a biopsy or not Report the likelihood that a lesion is malignant. Medical Image Processing The study of medical imaging is concerned with the interaction of all forms of radiation with tissues. The development of appropriate technology to extract clinically useful information, usually in the form of an image from the observed technology.  Non-invasive visualization of internal organs, tissues, etc. Most image-processing techniques involve treating the image as 2D or 3D. Molecular Bioinformatics Bioinformatics is also known as computational biology, is the study of biological systems through computational and statistical models It focuses on keeping, storing, and using the gathered information, but at a deeper biological level. The gathered information can be expressed graphically to allow clear trends and links to be made. The Future of Health Informatics Electronic Health Records (EHRs) and Interoperability: EHR adoption and the focus on interoperability to facilitate data sharing among healthcare providers. Telehealth and Remote Monitoring: Accelerated adoption of telehealth and remote monitoring technologies for virtual healthcare delivery. Big Data and Analytics: Increasing reliance on big data and analytics for predictive analysis, personalized medicine, and population health management. Artificial Intelligence (AI) and Machine Learning: Growing use of AI and machine learning in healthcare for tasks like image analysis, predictive analytics, and drug discovery. Mobile Health (mHealth) and Apps: The role of mobile apps and wearable devices in health monitoring, medication management, and patient engagement. Ethical, Legal, and Security Considerations: Ongoing discussions and regulations related to ethical use of health data, patient privacy, data security, and legal compliance. Lecture 2: Health Informatics Benefits Problems That Motivate Health Informatics 1) Population overgrowing, aging (increased life expectancy), undergoing increasing urbanization, and suffering more chronic preventable diseases. 2) The world is becoming more interconnected and infectious diseases can spread faster from one country to another (covid-19). 3) The overwhelming growth of medical knowledge 4) The impacts of climate change on communicable disease patterns, social disruption, and migration patterns will reduce the financial pool available for healthcare. 5) Increasing antibiotic resistance may challenge the very existence of hospital-based care. 6) Consumer expectations of their health practitioners are growing, and the cost of devices and medications are constantly rising *All have created a need for new models of healthcare(E-health) o E-health aims to shift health care system’s information and data from paper form into electronic form. o Accomplished by cooperation between the health sector and ICT sector to transform the old health, time and resources consuming system, into a more interactive and accurate system that can help in future development Application of Health Informatics in Healthcare Communication with healthcare professional via email Access medical records Research health information Tracking disease and monitoring public health Two Main Sectors of Healthcare Systems in Egypt 1, Public healthcare sector Operates under MOHP can provide emergency and primary healthcare to all Egyptian citizens. It works in three levels: a. Primary healthcare(PHC): Most of the primary health care units basically use paper-based system with a lot of records and documentation. However, they use E-database to keep death and birth certificate records. b. Secondary health care: This level deals with more complex problems, so it represents the first referral level for the primary health care. *There are three forms of secondary healthcare. B1. The district hospitals The hospital keeps only the patient’s basic information for each visit and adds it to the hospital paper visit's record. B2. University hospitals: There are 88 university hospitals in Egypt; only 56 hospitals have a basic e-health level. B3. Health Insurance. There’s one main website for all the health insurance institutions around the country. - Out of the 39 health insurance hospitals, only 4 hospitals have their own electronic information system c. Tertiary health care - A super-specialist care level provided by regional/central level institutions. - Tertiary health care systems provide intensive care level for patients with challenging diseases like oncology and heart diseases c1. Oncology centres: - Four out of eight oncology centres have websites showing their services for oncology patients. - All the patients’ records from all oncology centres, are collected periodically and sent to Nasser institution´s central database to represent a main resource for doctors’ research medication development and improvement. c2.AllHeartDiseaseInstitutions have non-interactive e-health information system 2, Private healthcare sector Private healthcare includes all healthcare institutions and hospitals that are not managed or funded by MOHP. i. Investment based hospitals: - Currently some have e-health information system in non-interactive and interactive form. - Most of the investment hospitals and clinics implement e-health first level to keep all patients’ information. - The first use of it is in the billing system. ii. Charity Private health care: a. The first type is either affiliated to religious institutions which haven’t any kind of electronic information about them, or affiliated to NGOs where hospital’s information is announced through the website of the NGO b. Hospitals funded by population: -It usually deals with tertiary care. Most of these hospitals offer the patient’s medical record in paper for more electronic form. -The most recognized establishment of excellence in this field in Egypt is the Children Cancer hospital 57357 which uses full e-health system since 2009. The Role of Informatics Implementation in Improvement of Healthcare I. Improve Quality of Healthcare Health informatics Specialists can review patient histories more quickly, improves quality of Improving the speed and responsiveness of patientcare. care through better Providing up-to-the-minute, real-time information about a record storage and patient’s condition necessary for decision making retrieval Recruit appropriate participants in clinical research studies, and understand the results, so researchers can develop new treatments more quickly and extend the reach for hard-to-treat diseases. Health informatics Providers, however well-trained, are human beings and subject to improves quality of error. care through When informaticists train computer systems to interpret improvement in radiological scans, those systems tend to make few mistakes. It diagnostics accuracy eventually saves lives by detecting cancers and other conditions earlier and with greater accuracy Health informatics Informatics systems designed to ensure that patients receive the improves quality of right medication the first time, care through - informatics systems Calculate and adjust doses based reduction of upon age, weight, renal function……. prescription error Preventing allergic reactions and dangerous interactions, detect and improve patient errors including duplication, mismatches and administration errors safety by cross-referencing prescriptions with patient records, - Software platforms like Computer Provider Order Entry Systems (CPOE) or Clinical Decision Support Systems (Patient care alerts/reminders). Clinical Decision Support (CDS):  provides timely information to help inform decisions about a patient's care and can significantly impact improvements in quality, safety, efficiency, and effectiveness of healthcare. Health informatics Speed up patient recruitment, improves quality of Streamline ethical approvals and renewal, care through making Boost levels of participant activity and make data collection and clinical research analysis easier. better build data warehouse that give researchers easier access to repositories of data from completed clinical trials for secondary analysis. Health informatics It is also called precision medicine, improves quality of -by collecting huge amounts of health data and translating that data into care through power individually tailored treatments. personalized medicine II. Health informatics expands access to care Data-driven telemedicine systems, virtual health care systems, and connected vital sign monitoring technologies make it easier for patients to consult with providers, regardless of location or time. Virtual hospitals and healthcare facilities bring healthcare services to underserved rural areas and developing nations Informatics also helps people get the care they need more quickly. Greater health-focused information technology investment is associated with shorter waiting times. III. Health informatics decreases medical cost *informatics can decrease costs by: Reducing medical error Reducing visits to hospitals and hospital congestion Reducing duplication of tests or prescriptions ordered. Making care more efficient and effective. Effectiveness: Achieving the best health outcomes. Efficiency: Maximizing resources and minimizing waste. IV. Health informatics improves population health by using data to predict and even prevent outbreaks of disease in a particular geographical area) Improve surveillance system, and help in the identification and prioritization of health problems It is behind immunization registries that collect confidential, population-based, computerized data about vaccinations; It is behind disease registries that track the incidence of certain conditions, especially cancers Lecture 3: Health Informatics Challenges Classification of HI Challenges System Resources Workforce Standards for interoperability Users Resistant staff Digital divide Data Security Ethics Privacy and confidentiality I. Cost Barriers A major challenge within health informatics is the financial investment required to develop, implement and maintain HI. II. The Need for Workforce One of the challenges to implementing health information and communication technology is the need for a skilled work force that understands healthcare, information and communication Targeting learners early in their training allows for gradual introduction of the EMR (electronic medical record) beginning with instruction on its functionality and implications for healthcare delivery, institutional documentation expectations, and subsequent hands-on practice. Students become comfortable with the EMR and its direct incorporation into clinical care, there by cultivating their EMR literacy and competency. III. Lack of Interoperability Interoperability is the capacity of various health information systems to speak with one another and exchange data with one another. Lack of interoperability leads to challenging in access and distribute of information across various healthcare practitioners and organizations IV. Resistant from health professional Health professionals and managers may be doubtful about such developments, particularly when they are satisfied with current methods of working They may perceive such discipline as diverting financial resources away from under- resourced clinical care. V. Digital Divide  The gap between people who have access to modern information and communications technology and those who don’t This has the potential to increase both the digital divide and the health divide for groups, such as homeless people, older people, people with specific disabilities (e.g. visual or cognitive impairment) and people in developing countries. VI. Concerns about privacy and confidentiality The portability of health information and sharing of electronic data create potential risks to privacy and confidentiality VII. Data Security Security is the technical methods by which confidentiality is achieved. Ensuring data security is challenging because: 1- Most software applications are vulnerable to exploitation 2- User behaviour, including sharing computer login passwords or using passwords that are easy to decode VIII. Ethical Issue Consent is required for analysing and sharing data Big data analytics can produce unexpected consequences, such as discrimination. It provides information on race, gender and religion, which may be used to discriminate against the customer. Need for standards to achieve interoperability Standardized definitions of data elements, standard languages, and commonly accepted vocabularies. Standardization of all computer hardware and software to ensure the electronic data interchange between healthcare information systems Overcoming the Challenges Policy Makers 1- Government institutions like the ministry of health should work actively with the aim of proper health informatics development. 2-Intersectoral collaborations between public and private sectors is mandatory to improve data infrastructure and workforce capacity. 3- Sustainable economic model for the healthcare sector should be developed by the policymakers incorporating health informatics and initiate infrastructure for it all over Egypt Uses 1- Training: literacy courses and training workshops towards the effective use of devices/tools/apps in health care. 2- Share examples of best practices to inspire and guide primary care practices to create a culture that embraces using health IT. Data 1- Information governance and ethical issues training will not only increase understanding of the importance but will empower them to influence decision-making in e-health. 2- Legislation is a practical road to guarantee the privacy of relevant personnel and make smart healthcare more secure Technology Develop and refine technology to produce high- functioning, interoperable health IT tools. Development of medical apps in Arabic language to solve the problem of language met by many Arab/Egyptian patients. Lecture 4: Clinical Information System (CIS) Hospital Information System: is an integrated, computer-assisted system designed to store, manipulate, and retrieve information concerned with the administrative and clinical aspects of providing services within the hospital Electronic Health Records (EHRs): the larger system that includes the EMR and PHR and interfaces with multiple other electronic systems locally, regionally and nationally / CMRs (computerised medical) / ECIS (electronic clinical information systems) / CPRs (computerised patient records) EMRs (medical): the electronic patient record located in an office or hospital. PHR (Personal / Patient Health Record): a collection of health information by and for the patient Interoperability: ability of different information systems, devices and applications to access, exchange, integrate and cooperatively use data in a coordinated manner, within and across organizational, regional and national boundaries, to provide timely and seamless portability of information and optimize the health of individuals and populations globally CPOE (computerised physician order entry): sometimes referred to as computerized provider order entry or computerized provider order management (CPOM), is a promising technology that allows physicians to enter orders into a computer instead of handwriting them / process of electronic entry of medical practitioner instructions for the treatment of patients (particularly hospitalised patients) under his or her care Clinical Information System: is a computer-based system that is designed for collecting, storing, manipulating and making available clinical information important to the healthcare delivery process. - Limited to single area (e.g. laboratory systems, ECG management systems) - they may be more widespread and include virtually all aspects of clinical information (e.g. electronic medical records) Areas Addressed by CIS 1-Clinical Decision Support System (CDSS): To aid in the making of correct, timely and evidence-based clinical decisions. 2-Electronic Medical Records (EMRs): This contains information about the patient, from their personal details to details of every aspect of care given by the hospital (from routine visits to major operations). 3-Training and Research: Patient information can be made available to physicians for training and research through data mining. Core Clinical Application of CIS (1) EHRs (Electronic Health Records) (2) CPOE (computerized physician order entry) systems (3) Decision-support tools. (4) Digital sources of medical evidence e.g. Systematic review and meta-analysis Importance of HER Limitations of Paper Records Handwritten notes and prescriptions are often illegible and hard to share. Paper records are costly to copy, transport, and store, and are easily destroyed. Analyzing paper records is difficult, and tracking who has accessed them is cumbersome. Environmental impact is negative due to paper waste. Advantages of EHRs  Legibility and Accessibility: EHRs enhance the clarity of patient information and allow rapid retrieval.  Organization: They provide structured data, making it easier to access lab results, X-rays, and summaries of patient histories.  Reduction of Missing Information: Studies show that up to 25% of paper charts are missing, while EHRs ensure comprehensive records.  24/7 Availability: Records can be accessed anytime, eliminating the need for physical storage and retrieval by staff. Collaboration and Coding  EHRs enable multiple healthcare providers to access and analyse information simultaneously, which improves collaboration.  They facilitate improved coding practices, as templates prompt clinicians to provide detailed documentation, potentially justifying higher billing levels. Clinical Decision Support Offers alerts and reminders, enhancing patient safety and care quality Benefits vs. Challenges of EHR Constrains to Adopt HER 1) The need for standardized clinical terminology 2) Privacy, confidentiality and security concerns 3) Challenges to data entry by physicians 4) Difficulties with integrating with other systems Importance for Interoperability in eHealth systems 1) delivering quality healthcare and reducing healthcare costs. 2) Health Information Exchange and Data Sharing Health information exchange (HIE), provides the capability to electronically move clinical information among disparate healthcare information systems and maintain the meaning of the information being exchanged. The goal of health information exchange is to facilitate access to and retrieval of clinical data to provide safe, timely, efficient, effective and equitable patient-centred care. HIE can also be used by public health authorities to assist in the analysis of the health of populations. Health Informatics Standards Standard : Something considered by an authority or by general consent as a basis of comparison ; an approved model. Health informatics standards: Document, established from evidence and by consensus and approved by a recognized body, that provides rules, guidelines or characteristics for activities or their results, in the field of information for health, and health information and communications technology. Standards Development Organisations (SDOs)  ISO :International Organization for Standard (also known as the International Standards Organization)  CEN :European Committee for Standardization  JIC :JIC for Global Health Informatics Standardization  HL7 :Health Level Seven International  Open EHR :Open Electronic Health Record Foundation   CDISC :Clinical Data Interchange Standards Consortium  ANSI :American National Standards Institute Purpose of HI Standards  At a general level, HI standards support clinical practice and the management, delivery, and evaluation of health services.  According to ISO, their specific purpose is to: 1) promote interoperability between independent systems, 2) enable compatibility and consistency for health information and data 3) reduce duplication of effort and redundancies. Types of Standards: 1. terminology *ICD-11-CM codes for diagnoses *CPT – Outpatient services and procedures *HCPCS- medical equipment and supplies *CDT- Dental services *SNOMED CT – clinical concepts *LOINC- Laboratory observations *NDC -pharmacy products *RxNorm- Clinical drugs * content  *C-CDA- clinical documents  *HL7 V2 and V3 – Clinical messages  *USCDI- Set of exchange data elements  Content standards dictate the structure of electronic documents and types of data they must contain. They ensure that medical data is properly organized and represented in a clear and easy to understand form. for example  C-CDA {Consolidated Clinical Document Architecture} designed by HL7 is the primary framework for creating electronic clinical documents in the US. It specifies how to structure medical records and how to encode data elements for exchange. * data exchange or transport standards * privacy and security standards Levels of CDSSs: (Level 1): all decisions by humans (level 2) : computer offers many alternatives (level 3) :computer restricts alternatives (level4) :computer offers only one alternative (level 5) : computer executes the alternative if the human approves (level 6) : human has a time line before computer executes (level 7) : computer executes automatically, then notifies human (level 8) : computer informs human only if requested (level 9) : computer informs human but is up to computer (level 10) : computer makes all decisions Some of Clinical Decision Support That is Still Available Today Lecture 5: Patient Informatics Patient Informatics (Consumer Informatics): Any electronic tool, technology, or system that is designed to interact with consumers (patients). *Consumers may use it with a healthcare professional or by themselves. *Examples of applications include disease management, lifestyle management, health promotion, self-care, and care-giving. Benefits / Importance: 1- Lower Administrative Workload: Automation of tasks like scheduling and billing improve efficiency. 2- Improved Access to Care: Digital tools expand access, especially in underserved areas. 3- Improved Patient Satisfaction: Easier access to healthcare providers enhances satisfaction. 4- Increased Adherence: Tools like appointment and treatment reminders improve compliance and outcomes. Patient Engagement Patients are more educated They strive for active participation They see root of problem Less effort to explain the problem Online communication Possibility of remote satisfaction assessment Patient Informatics Approaches 1. Health information and patient education  The internet is a powerful tool for patient education, offering numerous benefits in terms of accessibility, customization, and engagement.  The internet offers resources in various languages and formats (text, audio, video) to cater to different learning needs, including those with disabilities. Educational Tools 1- Websites of Trusted Health Organizations: Websites like the Mayo Clinic, WebMD, or government health departments provide trustworthy health information. 2-Online Medical Portals: Institutions provide patient portals with customized health information, test results, and care plans. 3. Interactive Educational Tools Videos and Animations: like YouTube offer instructional videos on health topics Webinars and Live Q&A Sessions: Healthcare providers can host sessions to engage patients in real- time. Lifestyle and Wellness Apps: Apps like MyFitnessPal or Headspace promote health literacy and active participation in care. Challenges to Consider  Misinformation: Patients may encounter unverified or misleading information.  Digital Literacy: Not all patients are technology users, so tailored education may be needed. Arabic Health Apps  mDiet, which was launched by Arabic Mobile Content (AMC), which suggests health diet recipes customized to the needs of all users based on the type of available and known foods in the Arabic countries  Faselty, an app. which aims to make it easy to connect blood donors with people in need  Es3efny an app. Providing a means of communication between ambulances and hospitals, using the Android platform, etc. 2. Web portals for patient access to their healthcare system.   Patient portals are secure online platforms through which patient can interact with doctors without a hurdle.  It provides a convenient way for patients to manage their healthcare and interact with their healthcare provider electronically Uses of Patient Portals  Mobile Access For Medical Records  Communication  Appointment Scheduling  Prescription Refill Request  To View Test Results  Payment  Telemedicine  Health Education Electrical Health Record (EHR)  An is a digital version of a patient’s medical file.  It is a comprehensive system that stores, manages, and provides access to patient health information electronically Components Benefits  Patient Data  Efficiency: Reduces paperwork  Clinical Features  Accuracy: Minimizes errors  Interoperability  Accessibility: Immediate access to real-  Decision Support time patient data.  Administrative Tools  Coordination: among different healthcare providers.  Patient Engagement: Portals allow patients to view their records, schedule appointments, and communicate with their providers. What Distinguishes EHR and Patient Portal?   A patient’s whole medical history and course of treatment are digitally stored in an Electronic Health Record (EHR), which is mainly utilized for clinical purposes by healthcare professionals.  Patient portals, on the other hand, are safe web-based environments where patients may interact with clinicians, plan appointments, get a portion of their EHR information, and take charge of their own treatment.  A patient-facing interface that allows access to a part of the EHR’s data is called the patient portal. The EHR is a comprehensive healthcare database or medical record 3. Patient health monitoring Remote Monitoring: devices transmit health data to physicians, enabling timely interventions.  Wearable monitor/trackers  Mobile health apps  Portal’s platforms Examples: Symptom Checkers: Help patients evaluate symptoms and decide if they need medical intervention Omada, Fitbit, Apple Watch, Active blood glucose monitoring, American Well 4. Patient communication (peers-physicians) i. patient-physician Virtual Consultations: Patients can discuss health concerns with providers remotely. Through: Platforms like Zoom, or specialized tele-health services allow real-time virtual consultations. Advantage of Virtual Consultations 1. Convenience and Accessibility: Location Independence-Time-Saving-Flexibility 2. Cost-Effectiveness 3. Enhanced Privacy and Comfort 4. Pandemic Resilience: Maintains continuity of services & prevent infection ii. Peer Communication  Forums and Social Media Groups: Patients can connect with others facing similar challenges, learning from shared experiences. Example: PatientsLikeMe Lecture 6: Digital Transformation in Healthcare I. Difference Between Digitization, Digitalisation, and Digital Transformation A. Digitization - Digitization is simply converting the information analogue or non-digital format into digital format. - Digitization makes all the information easily available and accessible in digital format. Example of Digitization: Converting music from CDs and vinyl records to MP3s or paper construction document to digital files saved on a computer * The process of digitization is the backbone for data recording, making it an important aspect of digital transformation B. Digitalisation - It is the very next step after digitization. digitalization cannot occur without digitization. - In digitization, physical objects or information are stored in computers, but the process where this data is used may be not changed so, digitization focuses on converting and recording data. - Whereas, digitalization is process driven. It utilizes the data collected through digitization process and converts the data to get useful outputs. - In short, Digitalization helps to improve the existing business process or processes by making the process more efficient, productive and profitable. Example of Digitalization - Digitalization include uploading a PDF document from computer’s hard drive to the cloud and sharing it with many people to analyse the data. Digitization related to information while digitalization related to operations *Digitalization embraces the ability of digital technology to capture and assess analytic data to make better business decision and enable new business models. C. Digital Transformation - Digital transformation’s primary aim is to integrate technology to most, if not all business operations. - It is the capacity to rapidly adapt when required through the intelligent use of technologies and information. - Digital transformation is the profound and accelerating transformation of business activities, processes, competence and models to fully leverage the changes and opportunities brought by digital technologies and their impact across society in a strategic and prioritization way. - Digital transformation aims to revolutionize the entire functioning of a company through the integration of digital technologies. This transformation is intended to enhance growth and competitiveness. Example of digital transformation - Automated teller machines (ATMs) came along and streamlined the basic transaction process, extending business hours and reducing wait times and dependencies on human employees for cash withdrawals and other popular II. Health Informatics or Healthcare Informatics   influences healthcare delivery, management, and planning, with the goal of improving clinical outcomes, lowering the cost of care, and bettering the patient and provider experience.  It is the interdisciplinary study of the design, development, and application of technology- based healthcare innovations.  is the study and implementation of computer structures and algorithms to improve communication, understanding, and management of medical information.  Health informatics is the application of information science and information technology in the service of better health and better healthcare.  We study, develop, and improve ways to use information in healthcare. III. Digital Transformation in Healthcare & Tools  Digital transformation in the healthcare market is all about adopting innovative technologies that are aimed at improving work efficiency in hospitals, as well as taking patient care to a whole new level.  This system enables quicker and more convenient access to electronic health records and significantly reduces the burden for the medical staff. Tools 1) Telemedicine, Telehealth & Virtual Visits  Telemedicine or the growth of virtual doctor visits is one of the most notable changes in healthcare.  Enables meeting the specialists at the most comfortable time and from nearly anywhere. Therefore, it is more time and cost-efficient rather than an in-person hospital visits and it allows the treatment of patients who are in remote areas and on regular basis.  Patients can schedule appointments, communicate with doctors via video chats using phones or PCs, receive detailed prescriptions in their emails, and more 2) Patient Portals (e-records) - Another great trend in the transformation healthcare solutions feature is creating specific healthcare platforms where the patients can:  Check prescriptions  Schedule appointments with the specialists   Ask for a consultation or get additional information from their doctors  Receive the laboratory results. - Share their health data with the healthcare provider. - This system enables quicker and more convenient access to electronic health records and significantly reduces the burden for the medical staff. 3) Health Wearables - At present, people have become more conscious about their health: they’re not visiting a doctor when they get sick, instead, they’re always looking for effective yet convenient ways to track their health metrics. - The digital transformation in healthcare enables tracking the various health metrics and providing accurate health data in real-time. Some of the common types of health devices include: Heart rate trackers Exercise & fit (duration, type of activity, distance, calories burnt, etc) Sweat meters (for tracking blood sugar - an essential routine of diabetics) Oximeters (for monitoring the oxygen carried in the blood - used for the patients with COPD, asthma, severe cases of COVID-19, and other respiratory illnesses) - One of the most popular wearables introduced on the device market is Apple Watch. - The smartwatch was first released on September 9, 2014, and so far, can track heart rate and exercise, reminders about drinking water or washing hands, used for recording body temperature, weight, and periods. - This data, in turn, can be later used by doctors for analysing health metrics, diagnosis, and more. 4) Disease History Analysis  Nowadays there are more and more tools that analyse a patient's disease history in order to give doctors recommendations about treatment outcomes.  Examples of such a solution is the company BostonGene. The BostonGene's algorithm conducts a profound analysis of a patient's previous conditions and offers a personalized treatment plan that would potentially deem the best results. 5) On-demand healthcare Patients want healthcare to be fully convenient to them and to fit into their schedule. More often, people obtain all the needed information online. They look for doctors, choose hospitals, and make appointments. 6) Big data in Healthcare (Blockchain) It enables healthcare to manage and analyse data more effectively than ever before and preventing data breaches. In addition, it can also be used to escape preventable illnesses, reduce treatment costs, as well as possibly forecast epidemics. 7) Artificial Intelligence (AI) and Machine Learning  Digital transformation in healthcare also uses AI and machine learning. It helps in analysing large amounts of data to recognize trends and patterns for improving healthcare outcomes. For instance, AI is analysing medical images to support diagnoses or to predict patient outcomes.  The real power of AI can be best observed in areas like precision medicine, imaging, drug discovery and genomics. 8) Robotics Robotics in the healthcare industry to support tasks such as performing surgery, administering medication, or assisting with rehabilitation. IV. Pros and Cons of Digital Healthcare Technology Pros:  The health information is securely preserved.  Like a health fit band, you can obtain real-time access to all your health-related data.  Digital health tools can also feature virtual reality (VR) and augmented reality (AR) technologies that make it easier to use.  Telemedicine is a fantastic way to bridge the gap between patients and healthcare professionals.  The quality of patient care is increased, whilst costs are also lowered and services made more convenient.  The Internet of Things (IoT) helps lower expenses, improve the patient’s experience, and reduces both errors and waste.  Cloud computing has numerous advantages in the healthcare field since it can provide high data availability, reliable backup, and disaster recovery. Cons:  The digital healthcare industry’s biggest difficulty is data processing because hospitals and similar platforms collect an enormous amount of delicate data.  Cyber security, like with any other digital platform, is a major issue in digital healthcare.  Users of digital services must be satisfied with them.  Finally, not all healthcare professionals are willing to adopt digital health technologies and remain in favour of more traditional methods.  Security and privacy are concerns for consumers.