Data Integration and Analysis I: Medical Information Systems › bitstream › handle › 1721.1 ›...

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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

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  • 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

    ++Add to that the following:asdfsaklfd0sljf safds asfdsdasfd adf asdfsafdasfd asfdsasfdsaasfdd fdsfadfs afsa adf

    asfdsdfadfadf asfdsafdadfsadfa

    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.

    /ColorImageDict > /JPEG2000ColorACSImageDict > /JPEG2000ColorImageDict > /AntiAliasGrayImages false /DownsampleGrayImages true /GrayImageDownsampleType /Bicubic /GrayImageResolution 150 /GrayImageDepth -1 /GrayImageDownsampleThreshold 1.50000 /EncodeGrayImages true /GrayImageFilter /DCTEncode /AutoFilterGrayImages true /GrayImageAutoFilterStrategy /JPEG /GrayACSImageDict > /GrayImageDict > /JPEG2000GrayACSImageDict > /JPEG2000GrayImageDict > /AntiAliasMonoImages false /DownsampleMonoImages true /MonoImageDownsampleType /Bicubic /MonoImageResolution 300 /MonoImageDepth -1 /MonoImageDownsampleThreshold 1.50000 /EncodeMonoImages true /MonoImageFilter /CCITTFaxEncode /MonoImageDict > /AllowPSXObjects true /PDFX1aCheck false /PDFX3Check false /PDFXCompliantPDFOnly false /PDFXNoTrimBoxError true /PDFXTrimBoxToMediaBoxOffset [ 0.00000 0.00000 0.00000 0.00000 ] /PDFXSetBleedBoxToMediaBox true /PDFXBleedBoxToTrimBoxOffset [ 0.00000 0.00000 0.00000 0.00000 ] /PDFXOutputIntentProfile (None) /PDFXOutputCondition () /PDFXRegistryName (http://www.color.org) /PDFXTrapped /False

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