生物信息学汇总教程-医学统计学-数据挖掘

MedicalInformatics,RepresentationandComputationonMedicalandHealthCareInformation,MedicalInformatics,HealthrecordsinpaperProblems:Highchancesofdamageofpatientrecords.Automatedprocessingofrecordsisimpossible.Increaseduseofelectronicmedia,devices.Advantages:Lesschancesofdamage,easeofmaintenance.Datainsertionandretrievalissimple.Easilyinteroperable.Migrationofhealthcareindustrytoelectronicdomain.,TargetedatDesignandDevelopmentofInformationSystemfor,MedicalScienceandTechnologyHealthCareServicesBusinessworldinvolvinghealthcare,HealthCareInformatics,Src:K.Siau,“HealthCareInformatics”,IEEEtrans.OnInfo.Tech.InBiomedicine,7(1),March,2003,pp.1-7,EnterpriseResourcePlanning,Fullintegrationofanorganizationsinformationfrompay-rollandhumanresourcestoaccountingandfinance.Databaseintegration(InformationSharing)Informationloggedonceandaccessedbydifferentmodulesmaintainingthedataconsistency.Trackinventory,orderinformationanddeliveryrequirementsDetermineequipmentusageandmaintenanceschedule,DecisionSupportSystem(DSS),ConventionalDSS:financialandscheduling.ClinicalDSS(CDSS):diagnosis,pharmacy,emergencyandnursingpractices.CDSSusedtosendalertsandreminderstopatientsaboutpreventivecare.,PatientRelationshipManagement(PRM),Primaryfocusondeterminingandmeetingpatientsneeds.Trackingpatientsinformationfromdietandexercisedatatopastdiagnosisinformationfromfamilyhistoryandallergyinformation.SendE-mailssatisfyingqueries,informingnewlypublishedhealthcarestudiesandremindingaboutpreventivemeasures.,MedicalInformaticsandTele-consultation,Inearlydaystele-consultationmeansSendingallhardcopiesofpatientrecords.takessignificantamountoftime.Sendthepatienttoaremotecenter.nearlyimpossibleforemergencypatient.Usingmedicalinformaticstele-consultationmeansSendingthemedicalrecordsonly.Mostofthetime,noneedtosendthepatient.Onlineconsultationamongdoctors.Largescopeofknowledgesharing.,Standards,HL7:HealthLevelSeven.Itisaninternationalhealthcarestandardformedicaldataexchangebetweencomputersystemsinhealthcare./LOINC:LogicalObservationIdentifiersNamesandCodes.Theseidentifythetestresultsorclinicalobservationsuniquely./ICD-10:InternationalStatisticalClassificationofDiseasesandRelatedHealthProblems.ICDprovidescodestoclassifydiseasesandawidevarietyofsigns,symptomsetc.Everyhealthconditioncanbeassignedtoauniquecategoryandgivenacode./classifications/icd/en/ICD-10-PCS:ICD-10ProcedureCodingSystem.ThisisasystemofmedicalclassificationusedforproceduralcodeswhichisdevelopedasareplacementofICD-9-CMvolume3(containsinpatientprocedures).DICOM:DigitalImagingandCommunicationsinMedicine.Thisisastandardforhandling,storing,printing,andtransmittinginformationonmedicalimaging./,MessageTransmission,HL7MessageStructure,Event,Message1,MessageN,Seg1,SegN,Field1,Field1,Comp1,CompN,Terminatedby,Separatedby|,Separatedby,MessageEncoding,Sequenceofsegmentsseparatedby|CompulsoryandoptionalsegmentsSegmentsassequenceoffieldsseparatedbyCompulsoryandoptionalfieldsAfieldisdescribedbyadatatype(e.g.ADdata-typedenotinganAddress),MSH|&|Clinic|Central|Reg|ADTA01|MSG00005|P|2.3EVN|A01|199601051530PID|2-687005|EvansCarolyn|19620324|F|903DianeCirclePhoenixvillePA19460|(610)5551212|(610)5551212|S|C|156962542PV1|E|Emergency|0148AddisonJames|SUR,AnexampleofHL7messageforpatientadmission,1.MessageHeader(i)From:Clinic(ii)To:Central2.Event(i)Date:1996-01-05(ii)Time:15:303.PatientIdentification(i)InternalPatientIDNumber:2-687005(ii)FamilyName:Evans(iii)GivenName:Carolyn(iv)BirthDate:1962-03-24(v)Sex:F,Admit/VisitNotification,3.PatientIdentification(contd.)(vi)StreetAddress:903DianeCircle(vii)City:Phoenixville(viii)StateofProvince:PA(ix)ZiporPostalCode:19460(x)Phone(Home):(610)5551212(xi)Phone(Office):(610)555-1212(xii)MaritalStatus:S(xiii)Religion:C(xiv)SocialSecurityNumber:156-96-25424.PatientVisit(i)PatientClass:E(ii)PointofCare:Emergency(iii)AttendingDoctorsID:0148(iv)FamilyName:Addison(v)GivenName:James(vi)HospitalService:SUR,Admit/VisitNotification(Contd.),FileasReferencePointer(RP)ofOBX,MSH|&|TELEMEDICINE|TELEMEDICINE|200808141246|ORUR01|SUR|P|2.4|EVN|R01|200808141246|PID|SUR05032008000|MandalPulinBihari|198003050000|M|Block-DVSRC,IITKharagpurKharagpurWestBengal721302India|91|754123|Hindu|NK1|1|SumitaMandal|Mother|Parikpur,HansdaWestMidnapore|OBR|4|ZIITKGP9903PatientImagesHL7IITKGP|200808141246|OBX|RP|ZIITKGP9903-1SamplebloodslideHL7IITKGP|SUR0503200800005032008BLD00.JPGTELEMEDIK2005IM|X|20080209|20080305|OBX|RP|ZIITKGP9903-2RoutineBloodtestsandGroupingBloodR/EHL7IITKGP|SUR0503200800005032008i0000.JPGTELEMEDIK2005IM|X|20080305|20080305|,MultimediafileisnotcontainedwithinHL7message.Referencepathtothefileiskeptinthemessage.MultimediafilehastobesentwithHL7message.,FileasEncodedData(ED)ofOBX,MSH|boundary=HL7-CDA-border-CDA-HL7EXT:=JPGTYPE:=BLDENTRYDATE:=20070117SIZE:=16601-HL7-CDA-border-CDA-HL7Content-Location:SUR1701200700017012007BLD00.JPGContent-Transfer-Encoding:BASE64Content-Type:image/pjpeg/9j/4AAQSkZJRgABAgEASABIAAD/7RBKUGhvdG9zaG9wIDMuMAA4QklNA+0AAAAAABAASAAAAAEADAwRDAwMDAwMDAwMDAwMDAwMDAwMDAwMDAwMDAwMDAENCwsNDg0QDg4QFA4ODhQUDg4ODhQRDAwMCgAyADAAMAAgADMANgAzAAoA-HL7-CDA-border-CDA-HL7-|X|200705091251|,ReferenceInformationModel(RIM),Rootofallinformationmodels.Providesastaticviewoftheinformation.AHL7-widecommonreferencemodelthatintegratesallTechnicalCommitteesdomainviews.CommitteesandSIGsgenerallyworkwithasmallsubsetoftheRIM-calledDomainInformationModelorDIM.FoundationClassesActsanintentionalactioninthebusinessdomainofHL7.Ex:patientobservationParticipationsexistsonlyinthescopeofoneact.Ex:surgeonRolesasociallyexpectedbehaviorpatternusuallydeterminedbyanindividualsstatusinaparticularsociety.Ex:doctorEntitiesphysicalthingororganizationandgroupingofphysicalthings.Ex:apersonActRelationshipTorelate2acts.RoleLinkTorelate2entityroles.,HL7v3MessageConstruction,HL7v3Message(Partial),.,HL7inTelemediK,DevelopedunderHL7v2.4specification.UsesFTPforHL7messagetransmission.MigratingtoHL7v3.0incomingdays.,ReferenceInformationModel(RIM),Rootofallinformationmodels.Providesastaticviewoftheinformation.AHL7-widecommonreferencemodelthatintegratesallTechnicalCommitteesdomainviews.CommitteesandSIGsgenerallyworkwithasmallsubsetoftheRIM-calledDomainInformationModelorDIM.,ReferenceInformationModel(RIM)contd.,FoundationClassesActsanintentionalactioninthebusinessdomainofHL7.Ex:patientobservationParticipationsexistsonlyinthescopeofoneact.Ex:surgeonRolesasociallyexpectedbehaviorpatternusuallydeterminedbyanindividualsstatusinaparticularsociety.Ex:doctorEntitiesphysicalthingororganizationandgroupingofphysicalthings.Ex:apersonActRelationshipTorelate2acts.RoleLinkTorelate2entityroles.,HL7v3Message:Anexample,.,LOINC,LogicalObservationIdentifiersNamesandCodes.Names&codesuniquelyidentifyobservations.LaboratoryObservationsClinicalObservationsAdministrativeObservationsCompatiblewithHL7andSNOMEDRepresentobservationinHL7message.,LOINC,Thefullyspecifiednameofatestresultorclinicalobservationhasfiveorsixmainparts:QRSAXISrepresentationinLOINC:QRSAXIS:ANGLE:PT:HEART:QN:EKG2951-2,LOINCinHL7,MessagegeneratorgeneratesamessagewithobservationresultsusingLOINC.SystemsupportsLOINC,parseHL7message,retrieveobservationresult.,OBX|TX|2093-3TotalcholesterolLN|0|78|mg/dl|F|20050223|,OBX-3:ObservationIdentifier,Code,Text,CodingSystem,DICOM,DigitalImagingandCommunicationsinMedicineStandardforhandling,storing,printing,andtransmittinginformationonmedicalimaging.Specifiesthefollowing-protocolsfordevicesclaimingconformancetoDICOMsyntaxandsemanticsofdatatobeexchanged.formatforstoringmediainDICOMcompatibledevicesetc.,DICOMCompositeImageIODInformationModel,DICOMWaveformIODInformationModel,DICOMWaveformInformationModel,Preamble(128bytes),DICM(4bytes),DE1,DEn,DICOMFileStructure,ExplicitVR,ImplicitVR,DICOMDataformat,DicomInformationStructure,AnExampleofDataElement,ExplicitVR,ImplicitVR,SomevitaltagsforrenderingimagesinDICOMStandard,DICOMinTelemediK,EmbeddedDICOMViewermodule.,PACS,PictureArchivingandCommunicationSystems.GoalsofPACSaretoimproveoperationalefficiencywhilemaintainingorimprovingdiagnosticabilityComputersornetworksdedicatedtothestorage,retrieval,distributionandpresentationofimages.PACSnetworkconsistsofacentralserverthatstoresadatabasecontainingtheimages.WebbasedPACSsystemisbecomingmoreandmorecommon.BasedonDICOMstandard,alsoacceptsothermediaformats.,PACS(Ref:,ICD-10,InternationalStatisticalClassificationofDiseasesandRelatedHealthProblems.ProvidescodestoclassifyDiseasesSigns,symptomsAbnormalfindingComplaintsExternalcauseforinjuryanddiseaseetc.Everyhealthconditioncanbeassignedtoauniquecategoryandagivencode.CanbeusedforMorbidity,mortalitystatisticsClinicaldecisionsupportsystem.,ICD-10,InternationalStatisticalClassificationofDiseasesandRelatedHealthProblems.ProvidescodestoclassifyDiseasesSigns,symptomsAbnormalfindingComplaintsExternalcauseforinjuryanddiseaseetc.,ICD-10,Everyhealthconditioncanbeassignedtoauniquecategoryandagivencode.CanbeusedforMorbidity,mortalitystatisticsClinicaldecisionsupportsystem.ThelimitationsofICD-9-CMLackofspecificityanddetails.CantsupporttransitionofIHDEetc.,ICD-10inHL7,Segmentfordiagnosis:DG12ndfieldofDG1:diagnosiscodingmethod(deprecated).4thfieldofDG1:diagnosisdescription(deprecated).3rdfieldofDG1:diagnosiscodeICD-10isusedtoconstruct3rdfield,DG1|H11.2ConjunctivalscarsICD10|F|20050223|,DG1-3:DiagnosisCode,IdentifierCode,Diagnosisdescription.,CodingSystem,ICD-10-PCS(ICD-10ProcedureCodingSystem.),Medicalclassificationusedforproceduralcodes.Codesarecomprisedofsevencomponents.Eachcomponentiscalleda“character”.AllcodesaresevencharacterslongIndividualunitsforeachcharacterarerepresentedbyaletterornumber.Eachunitiscalleda“value”34possiblevaluesforeachcharacterDigits0-9LettersA-H,J-N,P-Z,SNOMED,SystematizedNomenclatureofMedicine.Collectionofmedicalterminologycoveringmostareasofclinicalinformation.DiseasesFindingsProceduresMicroorganismsPharmaceuticalsetc.,Standardization:ComplexityinMedicalWorld,Vastanddynamicknowledgebase.Closeinteractionofdifferentcomplexsystems.PatientManagement,DiagnosisandInvestigations,TreatmentandProcedures,Drugandpharmacology,Diseaseclassificationetc.ProcessStandardization.Regionalanddemographicvariations.Adjustmentwithreal-lifeconstraints.Infrastructure,Humanresource,Materialresource.,IndianHealthcareScenario,Presenceofdisparatehealthcaredeliverymechanism.Paperbasedtransactionacrossthehealthcarespectrum.Sheervarietyofadministrativesystemsmakestheprocessinefficientandcumbersome.Lackofindustrystandardsleadtofurtherconfusionandincreasesthegap.,ConsequencesUnabletoachievethebenefitsofautomationofwork.Severalhealthcentersbutnointerconnection.,CompatibleSystems:Communicatingsystemshouldbecompatibleforseamlessdatacommunication.MedicalStandardization:Severalhealthcarestandardsavailablecurrently.Acceptabilityvarieswithrespecttohealthcarescenariosindifferentcountries.HL7,LOINC,DICOM,ICD-10,PACSaremostpopularstandards.,Contd.,Interoperability:Twoways,EffortforStandardizationinIndia,HealthUnite:EffortofMCIT,AH