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transcript
Biomedical
Information
Technology
2.771J BEH.453J HST.958J Spring 2005
Lecture 26 April 2005
Data Integration and Analysis I:
Medical Information Systems
© cfdewey 2005
Biomedical Information Technology
DATA INTEGRATION AND ANALYSIS I
Integration in the hospital environment ¾ Imaging and information flow ¾Use of DICOM standard ¾ The personal healthcare record ¾HL-7: the hospital standard for data interchange ¾ IHE: Integrated Healthcare Environment
The importance of use cases: York Hospital Adding metadata to medical records ¾ DICOM Structured Reporting (SR) ¾ Snomed
© cfdewey 2005
Biomedical Information Technology
Information flow in health care delivery
EpidemiologyStudies
Main Control
Resources
DiagnosticDatabase
ImageStorage
DiagnosticProcedure
Treatment Procedure
DiagnosticStatistics
Resources Treatment Statistics
Local Control
Local Control
© cfdewey 2005
© cfdewey 2005
Here’s a diagram of what is there today . . . . .
Radiology
Primary Care
Admissions
Laboratories
Hospital Administration
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Semi-automatedPaper and film
BiomedicalInformationTechnology
Biomedical Information Technology
Integrating the hospital information entities
Radiology Pathology Cardiology Intensive Care Others
DICOM Data Repository
DICOM Data
MRI X-Ray CAT-Scan Ultrasound Electrocard.
Devices
Services © cfdewey 2005
Biomedical Information Technology
The personal Electronic Medical Record
(EMR)
Patient Treatment
Patient Information
Diagnostic Protocols
Pharmacy and Other
DICOM Data Repository
Electronic Medical Record
© cfdewey 2005
Biomedical Information Technology
The enterprise healthcare systemThe enterprise healthcare system
Patient Admission
Outcome Studies
Physician Contacts Billing
DICOM Data Repository
Electronic Medical Record
Healthcare Enterprise Systems
© cfdewey 2005
York tHeal hSM
S Y S T E M
Integrating Medical Imaging with a
Person-Centric EMR
WilliamWilliam ““BuddyBuddy”” GillespieGillespieChief Information OfficerChief Information Officer
www.yorkhealth.orgwww.yorkhealth.org19981998
Courtesy of William Gillespie. Used with permission.
© cfdewey 2005
YorkHospital
YorkMedicalGroup
Remote Clinicsand Facilities
HomeHealthcareFacilitiesAmbulatory
CenterApple Hill
Laboratoriesand DiagnosticCenters
HealthCentral
Employers
Payors
Affiliated an Offices
Physician 3Physician 1 Physician 2
South CentralPreferred
©
York
York Medical
Laboratories
Employers
Payors
YHS NETWORK
Physici (PHO, MSO, HMO)
Electronic Medical Record
South
Integrated Delivery NetworkYork l hS Y S T E M SM
cfdewey 2005
Hospital Group
Remote Clinics and Facilities
Home Healthcare Facilities Ambulatory
Center Apple Hill
and Diagnostic Centers
Health Central
*Indemnity *Medicare
*HMO/PPO *Medicaid Affiliated Physician Offices (PHO, MSO, HMO)
Physician 3 Physician 1 Physician 2
Central Preferred
t Hea
Courtesy of William Gillespie. Used with permission.
Berks County
Hospital
York-Adams
Franklin-Fulton
Lancaster-Chester
Penn State Geisinger Health System
Capital Region
Health System (Hershey)stem
Regional AffiliationsYork tl hHea
SM
S Y S T E M
Reading St.
Summit Health
Summit Health (Waynesboro)
Hospital
Ephrata Hospital
CommunityHospital
HospitalSt. JosephHospital
inger
Hospital
Hospital
Sy
Joseph Medical Center
Community General Hospital
York Health System
Memorial Health Systems
Hanover HealthCare Plus
Gettysburg Hospital
(Chambersburg)
Columbia Lancaster Health Allianc e Brandywine
Pinnacle Health Syst em
Penn State GeisHoly Spirit
Commun ity General H ospital
G ood Samaritan
Pinnacle H ealth
Carlisle Hospital
Courtesy of William Gillespie. Used with permission. © cfdewey 2005
York Heal ht York Hospital Information FlowsSM S Y S T E M
Lab Medical Pharmacy Food SvcMtl MgmtCardiology OR
Pat Mgmt
Registration
General Ledger
EMR
Imaging
© cfdewey 2005
Courtesy of William Gillespie. Used with permission.
York Health System Information Flows
Medical
Registration
General Ledger
EMR Pat Mgmt
Data Warehouse
EMPI
Registration Registration
Billing Tracking
Hospital Physicians
Managed Care
York tl h S Y S T E M
SM
Imaging
Hea
Courtesy of William Gillespie. Used with permission. © cfdewey 2005
Biomedical Information Technology
Generation and storage of metadata
Diagnostic analysis ¾Track and record changes to the image ¾ Store results (see MS image segmentation) ¾ Coding systems HL-7 Snomed ICD 9/10 UMLS
Structured Reporting ¾ Originated with DICOM ¾ Is broader than DICOM
© cfdewey 2005
Biomedical Information Technology
Diagnostic coding systems
Long history of nomenclature attempts
¾ ICD ¾ DRG ¾ Read Codes
¾ Unified Medical Language System (NLM)
SNOMED is the current most accepted standard
“SNOMED Clinical Terms provides a common language that makes
health care information accessible and usable, whenever and wherever it is needed, to improve health care across primary and specialty medicine settings internationally. Government entities and healthcare organizations in 28 countries have adopted SNOMED CT since its release in January 2002.” www.snomed.org
Ref: J.J. Cimino, Meth. Info. In Medicine 35: 273-284 (1996) © cfdewey 2005
Biomedical Information Technology
Hospital information coding systems
HL-7 ¾ Started as simple set of transaction codes ¾ Grew to some 3,000 tags with definitions Current version 2.08, March 2005
¾ Tags are a cumbersome way to enforce ontologies HL-7 Version 3 is an object model ¾ Object model ¾ Strangely silent since 2002 ¾ Had major effort and use cases; see handout
www.HL7.org © cfdewey 2005
Biomedical Information Technology
Metadata: viewing medical images
Diagram removed for copyright reasons.
Depiction of different views and functions on a given image:
magnifying glass, window/level, zoom, pan, flip
vertical/horizontal, invert, annotate.
© cfdewey 2005
Biomedical Information Technology
A complex case at BWH, Harvard Med. School
Multiple sclerosis Design ¾100 patients ¾20 time points/patient ¾Four 3-D MR images/time point ¾60 GB raw data
Analysis Courtesy of Dr. Charles Guttmann. Used with permission. ¾Segmentation of 3-D images for
lesions
¾Time course of lesions (another 40 GB) ¾Associated patient genetic database © cfdewey 2005
Biomedical Information Technology
Advanced image processing architecture
Component Sharing & InteroperabilityComponent Sharing & Interoperability
Efficient Architectural Model:
PP WR
Image Database Memory
Database
Image Stream / Pipeline Processing
Efficient Execution Model:
= Edge (Gray (Sharpen ( ) ) )
© cfdewey 2005
Biomedical Information Technology
Integration of metadata: An example of aStructured Report (SR)
Ref: David A. Clunie, DICOM Structured Reporting,
PixelMed Publishing, 2000, p 30
© cfdewey 2005
Courtesy of Dr. David Clunie. Used with permission.
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