Presented by Dr Dave Parry(1) and Dr Inga Hunter(2) (1) Auckland University of Technology (2) Massey University

1. An introduction

2.  What is health informatics?
 Why is it important?
 What does health informatics include?
 What does it mean for me?
 How do I find out where to learn
more?

3. Collect
Store
Share
Use
Maintain

4. Collect
Store
Share
Maintain

5.  the study of information processing as it is
used in healthcare
 the field that deals with the storage,
retrieval, sharing, and optimal use of
health information, data, and knowledge
for problem solving and decision making
 includes science and practice of
healthcare, its information and knowledge
and their management with information
and communication technologies to
promote the health of people, families and
communities world wide

6.  HINZ – www.hinz.org.nz
 IMIA - www.imia.org
 Health IT cluster - www.healthit.org.nz
 Ministry of Health - www.health.govt.nz
 National Health IT Board -
www.ithealthboard.health.nz

9.  Particular commitment to “patient controlled
record” by 2014
 eHealth Vision
◦ “better access to information about our health”
◦ “better, sooner, more convenient health care”
◦ integrated consumer-centred care
◦ having access to their own health information
◦ improving electronic storage
◦ share information regionally and nationally
◦ consolidated platform for shared care
◦ high quality health care and improved patient
safety

10.  Electronic Health Records
 Knowledge Management
 Decision support
 Telemedicine and telehealth
 Standards
 Evidence for benefit/harm
 Ethics and Security

11. Communications
Data collection
and analysis
Knowledge
Decision support
Electronic health record
Surveillance, Public Health
Coding
ICD10 - Classification
Messaging, HL7
Telecare
EHealth
MHealth
Evidence-Based Practice
Ontologies and vocabularies
All aiming for better health outcomes

13. October 2012
“The Herald understands staff allegedly
accessed the man's medical file and emailed the
x-rays. It is understood the incident could lead
to court action against those involved.”
 What technology is involved and is this a
technological issue?

14.  They don’t learn
 They can’t tell what you mean
 They don’t get bored

15.  Discrete variables
 National Health Index – NHI
 Name, date of birth, gender, address
 Values collected – blood test results
 Clinical data - blood pressure, clinical signs,
diagnosis, medications
Data itself is nothing…
Should provide useful, usable
information that makes a difference
to patient care

16.  Data in context
 120/80 means something if you
know it is mmHg
 However it still doesn’t tell you
anything about whether the patient is
sick or well.
 Need more data to provide context –
when taken, other readings, age,
medical history, medications

17.  Adds MEANING to information
 120/80 is high blood pressure in an
infant
 May be high relative to other readings
in an adult
 Relies on expertise to interpret.
 Information to knowledge usually
done by humans, can see clinical
diagnosis as this sort of process…
 Can utilise Decision Support Systems

18.  NHS direct…
 https://www.nhsdirect.nhs.uk/CheckSympto
ms/SATs/GeneralIllness12AndOver

19.  Patients
◦ Self treatment and support
 Clinical staff
◦ Support diagnosis and treatment
 Administration and funders
◦ Cost Estimation
◦ Management
◦ Resource allocation
◦ Outcomes

20. • What are EHRs?
• Examples of EHRs
• Issues with EHR

21.  “Computer-based systems for input, storage,
display, retrieval, and printing of information
contained in a patient's medical record” – Pubmed
 Part of a clinical information system relating to
individuals
 Records information about a person:
◦ Presenting symptoms
◦ Results of tests and clinical examinations
◦ Encounters with health professionals
◦ Treatment and plans for further management

22. Electronic
Health Record
Laboratory results
Administration Systems
Imaging (including PACS)
Clinical users
Government and
provider statistics
Other health care
providers
Etc.
Middleware e.g. Web Portal

23. A NZ veterinary practice is advertising online
that they offer electronic health records for
pets. If your Vet is closed another in the town
can see your pet and access their health record
and provide care.
Why can’t we do this for people too?
 What do you think might be the potential
benefits of EHRs?
 What might be some of the issues for EHRs?

24.  Always available
 Legible
 Searchable
 Sharable
 Different views
 Audit and decision support
 Security

25.  Consistency of data
 Free text versus coding
 Security – who can access and when
 Protecting an individual's privacy
 Need a computer
 “Fishing expeditions”
 Sharing information safely

26.  Orion
http://www.orionhealth.com/solutions/packages/electronic-
health-record-ehr
 Medtech
http://www.medtechglobal.com/nz/products/medtech32-
nz.html
 Microsoft – health vault
http://healthvault.com/hvindex.htm?rmproc=true
 Personal health records
 Web 2.0 Medical records

27. Data collected should be available for:
 Supporting clinical intervention
 Clinical Governance
 Administration (in all parts of health)
 Strategy and policy development
 Research

28.  Patient (consumer) self-management and self
care.

29.  Use data from Electronic Health Record
combined with rules
 Reminders – eg high blood pressure,
protocols
 Decision Analysis – need utility values
 Alerts
 Linking to resources
 Recalls-Cervical screening, immunisations
 Telehealth

30.  Data to record diagnoses, observations,
outcomes.
• Coding - Diagnostic related groups (DRGS)
◦ ICD 10 codes
◦ Read codes
◦ Snomed CT
 Vocabularies – to standardise terms, shared
meanings
◦ Pre-eclampsia, PE, Toxaemia, PET, Gestational
Proteinuric Hypertension GPH

31.  International Classification of disease (ICD) currently
version 10.
http://www.who.int/classifications/icd/en/
 World Health Organisation standard
http://www.cdc.gov/nchs/about/otheract/icd9/icd10cm.ht
m
ICD10 Code Description
O104.11 Pre-existing secondary hypertension complicating pregnancy, first trimester
O104.12 Pre-existing secondary hypertension complicating pregnancy, second trimester
O104.13 Pre-existing secondary hypertension complicating pregnancy, third trimester
O104.19 Pre-existing secondary hypertension complicating pregnancy, unspecified trimester

33.  http://www.health.govt.nz/nz-health-
statistics/classification-and-
terminology/new-zealand-snomed-ctr-
national-release-centre _ NZ release centre
 Free to use
 Endorsed standard

35.  Global standard
 Hierarchical
 Concepts - also link concepts
 Synonyms and different languages
 >600,000K Concepts
 clinical vocabulary administered by
international health terminology standards
development organisation (IHTSDO)
http://www.ihtsdo.org/.
 Member countries; Australia, Canada,
Denmark, Lithuania, Netherlands, NZ, Sweden,
UK & USA

36.  http://www.health.govt.nz/nz-health-
statistics/classification-and-
terminology/new-zealand-snomed-ctr-
national-release-centre _ NZ release centre
 Free to use
 Endorsed standard

37. Unstructured text
Extract SNOMED terms
EHR
Map to ICD 10 Send/receive messages

38.  Structured Pathology Reporting for Cancer from Free Text: Lung Cancer
Case Study
 Anthony Nguyen, Michael Lawley, David Hansen, Shoni Colquist

Abstract
 .
Results: Checklist items were identified in the free text report and used
for structured reporting. The synthesised TNM staging values classified
by the system were evaluated against explicitly mentioned TNM stages
from 487 reports and achieved an overall accuracy of 78%, 89% and 95%
for T, N and M stages respectively.
Conclusion: A system to generate structured cancer case reports from
free-text pathology reports using symbolic rule-based classification
techniques was developed and shows promise. The approach can be
easily adapted for other cancer case structured reports.
 http://research.ict.csiro.au/software/snapper

40.  Communication of information is a
key task in health informatics
 Communication must be accurate,
reliable and timely
◦ Prescriptions (from hospital or GP to
Pharmacy)
◦ Referrals (from GP to hospital)
◦ Discharge Summaries (from hospital to
GP)
◦ Lab results

41.  Potential architectures
 Single Clinical Information system
◦ Everybody accesses own part and gets views of
other data.
 Centralised model
◦ Requires very large investment
◦ Issues with who “owns” data
◦ Connectivity always needed – robust & 24/7

42.  Independent systems that communicate
 Low investment needed
 Fewer issues with ownership
 Only data that needs to be transferred is
sent
 BUT
◦ N(n-1) connections
◦ Interface issues
◦ Who looks after it ?

43.  Standard message formats (HL 7 –
simple way to format message for safe
transmission)
 Use VPN, SSL and other encryption to
allow use of standard commercial
infrastructure
 DICOM - A system for transferring
images, including X-rays, ultrasound
etc. Aims to prevent image information
separating from patient data.

46.  Treaty of Waitangi
 Professional codes of conduct
 Privacy Act & Health Information Privacy
Code
 Technological solutions:
◦ Audit trails – who looked at the data
◦ Industry-standard security and authentication
◦ Rules for data preservation
◦ Data consistency and cross-checking
◦ Sealed envelopes

47.  Rule 1: Purpose of collection of health information
 Rule 2: Source of health information
 Rule 3: Collection of health information from
individual
 Rule 4: Manner of collection of health information
 Rule 5: Storage and security of health information
 Rule 6: Access to personal health information
 Rule 7: Correction of health information
 Rule 8: Accuracy etc of health information to be
checked before use
 Rule 9: Retention of health information
 Rule 10: Limits on use of health information
 Rule 11: Limits on disclosure of health information
 Rule 12: Unique identifiers

51. QUOTE: The past is gone; the future is unknown
-- but the present is real, and your
opportunities are now.
QUESTION:
From what you have seen and read list trends
that will be more dominant in the future of
technology and health care.

52.  International trends include:
◦ Communication technologies
◦ Portability
◦ Digital divide
◦ Changing public
◦ Genomics
◦ Tele-health

53.  What basic information literacy skills
should health professionals possess?
 Where and how should they get the
education for this?
 To what extent should health
professionals be trained in IT to enable
them to work with health information
systems?

54.  Professionals in health and IT need the skills
that provide for
◦ lifelong learning
◦ career development
◦ critical thinking ability
◦ communication skills
◦ information literacy
Follow Up:
Personal assessment and plan
International Computer Driving License