MedicalInformatics MCV 2002

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Published on January 12, 2008

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Medical Informatics::  Vlad Olchanski, PhD o Moscow Institute of Physics and Technology o Institute of Control Sciences o International Institute for Applied Systems Analysis o World Health Organization o Medical College of Virginia November 7, 2002 Richmond, VA MCV Course for 4th year medical students Dr. Olchanski Home Page Download content as MS PPT presentation Medical Informatics: Computers, Decisions, and Communications Medical Informatics:  Medical Informatics Outline of Lecture Informatics: Philosophy of Governing Life Component 1 Information Technology Computers Communications Internet Component 2 Decision Support and Theory Medical Records Diagnostic Support Pharmaceutical Prescriptions Health System Modeling Data Mining Overview of the subject and a couple of practical advises Medical Informatics:  Medical Informatics INTRODUCTION Download content as MS PPT presentation Phi Beta Kappa - philosophia biou kybernetes Philosophy Governs Life:  Phi Beta Kappa - philosophia biou kybernetes Philosophy Governs Life Philosophy Mathematics Natural Philosophy Physics Engineering General Theory of Systems Cybernetics Informatics General Theory of Systems:  General Theory of Systems Bertalanffy (Austria-Hungary), Bogdanov (Russia) - 1908 Crash of empires after the Great War The Second World War: FLAK Norbert Wiener (MIT): Cybernetics: Control and Communication in the Animal and the Machine - 1948 The Second World War: Enigma Theory of Information, Finite Mathematics, Probabilities John von Neumann (Princeton) Alan Turing (Bletchley Park) Claud Shannon (MIT) Andrey Kolmogorov (Moscow State) Cybernetics:  Cybernetics Theory of Information Communications Coding Algorithms Probabilities and Stochastic Processes Theory of Control Operations Research Optimization Management Science Systems Analysis Applications:  Applications Live, bio-systems Engineering, machines, robots Organizational systems Computer Science Systems Analysis Decision Support, Artificial Intelligence Whence Informatics?:  Whence Informatics? Concept of Cybernetics turned too broad Word Cybernetics tarnished, devalued by Sci-Fi and Pop culture Pragmatic reduction to Computer Science in USA CS translated into INFORMATIQUE in France Backward translation of CS as INFORMATICS expanding the scope Handbook of Medical Informatics:  Handbook of Medical Informatics http://www.mieur.nl/mihandbook http://www.mihandbook.stanford.edu/ This excellent book unfortunately has very little coverage of the Internet applications. Otherwise, this is the #1 Resource! Medical Informatics Definitions:  Medical Informatics Definitions Medical Information Science is the science of using system-analytic tools . . . to develop procedures (algorithms) for management, process control, decision making and scientific analysis of medical knowledge - Ted Shortliffe Medical Informatics comprises the theoretical and practical aspects of information processing and communication, based on knowledge and experience derived from processes in medicine and health care - Jan van Bemmel Whence Informatics?:  Whence Informatics? Computer Science and Informatics are practically synonyms: the difference in emphasizing the application aspect Informatics is frequently understood as broadly as Cybernetics -- Information Processing including Decision Making and Systems Analysis Informatics - What?:  Informatics - What? Information Technology and Theory Computers, Communications, Data Processing, Algorithms Decision Theory and Applications Bayesian Approach, Expert Systems, Artificial Intelligence, Knowledge-based Systems, Algorithms A Good INTRO to Informatics:  A Good INTRO to Informatics But should we go all the way together? Medical Informatics:  Medical Informatics INFORMATION TECHNOLOGY COMPUTERS Download content as MS PPT presentation Computers: Evolution:  Computers: Evolution Von Neuman and the first MAINFRAME at IAS (1948) Vacuum tubes, punch cards or tape Batch mode of operation Low reliability - maintenance team of electronics engineers Transistors - Bill Shockley, 1956 NP MINICOMPUTERS Interactive mode of operation Higher reliability due to Transistors MICROCOMPUTERS Interactive mode of operation Reduced size and enhanced reliability due to Integrated Circuits PERSONAL COMPUTERS Renamed from minicomputers to show due respect SUPERMINIS WORKSTATIONS SUPERCOMPUTERS Programming Mainframe:  Programming Mainframe Booting your computer -- giving it a kick? No! It is short from bootstrapping. “Bootstrap” was the name of a short length of the punched tape that was fed to a computer to initiate loading of the Operating System. Medical Informatics:  Medical Informatics INFORMATION TECHNOLOGY COMMUNICATIONS Download content as MS PPT presentation Communication Protocols:  Communication Protocols Standards - 7 layers of ISO communication protocols from bits, wires to applications Internet protocols FTP, Telnet, Email, NNTP, HTTP==WWW Communications include - Noise elimination in the channel Coding (error detection and correction) Encryption (security) Internet Internet Protocols:  Internet Protocols FTP (file transfer protocol) serves to exchange data with a remote computer Telnet allows to run programs on a remote computer Terms: Upload - send TO a remote recipient Download - receive FROM a remote sender Remote Computing - I:  Remote Computing - I Wilma at CUNY has data, needs report! Fred at UBC has report software... Slide21:  Remote Computing - II Wilma at CUNY has data, needs report! Fred sends Wilma the username and the password Never by EMAIL !!! Slide22:  Remote Computing - III Wilma uploads her data with FTP Fred at UBC has report software... FTP Slide23:  Remote Computing - IV Wilma manipulates her data on Fred’s computer with Telnet Fred at UBC has report software... Telnet Slide24:  Remote Computing - V Wilma downloads the report with FTP Fred at UBC has report software... FTP Slide25:  Remote Computing - VI Wilma prints the report in her office and sends her kisses to Fred by email Fred at UBC has report software... Email Remote Computing -Security:  Remote Computing -Security Using Email - 1:  Using Email - 1 Email is very much like Regular Mail: sending mail and receiving are done quite differently! To send mail, you may drop a letter in any mail drop box in the street. To send email, you may connect and use any SMTP server in the world. It is for public convenience. SMTP server sends email Using Email - 2:  Using Email - 2 You send a letter thru a Mail Drop Box You may use any one you find in the street Using Email - 3:  Using Email - 3 You send an email thru a SMTP server You may use any one you find in the Internet access controlled access controlled access controlled access controlled access controlled access controlled open for all Using Email - 4:  Using Email - 4 Email is very much like Regular Mail: sending mail and receiving are done quite differently! To receive mail, you must have either your own mailbox or rent a box at any Post Office. To receive email, you must have an account with any POP3 server. It will be your private possession. You may have as many as you may wish. POP3 server receives email Using Email - 5:  Using Email - 5 To receive a letter, you must have a home or a number in a US Post Office Using Email - 6:  Using Email - 6 To receive an email, you must have an account at a POP or IMAP mail server you may have as many of these as you like Using Email - 7:  Using Email - 7 POP server delivers all messages to your computer -- good when you are on a fast connection IMAP server delivers only message headers and messages on demand -- good when you are on a dial-up Yet you will not have all messages on your computer Mozilla, Eudora, TheBat! support multiple email accounts Webmail allows to use email with your browser -- good when you are on the go The poor and street people use Hotmail, Yahoo, etc. -- but it is not a true email Using Email - 8 Basic Rules of Nice Conduct:  Using Email - 8 Basic Rules of Nice Conduct 1. Never consider email as confidential 2. Email should best be a simple message 3. Do not send messages formatted with HTML -- not all email clients can deal with them, it confirms a hit for spammers (impossible not to use in AOL email program ) 4. Avoid sending binary attachments these may come corrupted and can carry viruses How to avoid binary attachments in Email, see “http://www.intmed.vcu.edu/inm/advice.html” The Most Intimate Secret:  The Most Intimate Secret Like Wine dichotomy in Russia - White wine: Moonshine, Vodka, Brandy - Red wine: all the rest The Most Intimate Secret:  The Most Intimate Secret Data dichotomy in Internet - Text files: Plain English text: A-Z, a-z, 0-9 - Binary files: all the rest The Most Intimate Secret:  The Most Intimate Secret Symbols -- Bytes -- Octets Bits Secret == 53 65 63 72 65 74 1010011 1100101 1100011 1110010 1100101 1110100 Sept “bits” fassent un “octet”! This is the ASCII Standard. This has been implemented in communication networks hardware. Yet -- Éç == C9 E7 == 11001001 11100111 Now you see that the French have a reason to call the “byte” not “septet” but “octet”! If you strip the 8th bit then corruption occurs: É -> 49 == I and ç -> 67 == g The Most Intimate Secret:  The Most Intimate Secret The Revelation Only text files may be sent through Internet Binary files will come corrupted To send a binary, it must be converted to a text file (encoded) and on the receiving end the encoded file must be decoded. In FTP protocol, the type must be told explicitly In Email, binary files go as attachments. There are different encode/decode procedures which may lead to confusion and errors Security: Cryptography:  Security: Cryptography I send message to Fred Fred reads my message I read Fred’s answer Dear Fred, bla-bla... Dear Fred, bla-bla... ]hk@s#2kdMs0fHquja... Fred’s public key Fred’s private key Dear Vlad, bla-bla... Dear Vlad, bla-bla... Msios$[\iqN7dkoZnu... My private key My public key Fred answers my message Communications. Security:  Communications. Security 80% trash, 5% pearls Internet Protocols:  Internet Protocols Usenet, News, Forums -- NNTP Protocol A small ISP carries ~45,000 groups. Different ISPs give different groups, have different scopes Medical and Health Related Groups listed: www.mipt.vcu.edu/ng.html Internet Protocols:  Internet Protocols World Wide Web == HTTP protocol User client -- browser Opera, Mozilla, Netscape, Internet Explorer WWW is only a small part of Internet !!! AOL and MSN are not Internet at all !!! Internet AOL MSN gateway gateway Internet Services Providers give you full Internet archive.salon.com/tech/feature/2001/06/26/locking_up_the_web/index3.html Internet Protocols:  Internet Protocols Web Browsers web standards are important for compatibility longevity of websites, and future development Opera and Mozilla are W3C compliant Internet Explorer violates the standards (version 6 may comply) has many security holes Netscape 4 is incapable to view modern websites Netscape 7 is a commercialized version of Mozilla 1.0 Replace Netscape 4 with Opera or Mozilla! MSN Internet Connectivity:  Internet Connectivity A decent ISP must give a client: o SMTP address to send email o POP3 address to access the mailbox o NNTP address to get Newsgroups Additionally: o Space to host website at ISP’s IP address o FTP access to update website Optionally: o Fixed IP address for hosting own website Web Design:  Web Design What is a good website? -- presentable for all users: WIN, Mac, Unix, etc. -- acceptable for all browsers: Opera, Netscape, MSIE, etc. -- loads fast: byte size < 50 kB -- does not use Cutting Edge technologies Learn the culture of Web Design at webpagesthatsuck.com review the Daily Sucker site daily! Information Technology Basics of Security:  Information Technology Basics of Security make sure workstation is physically safe and secure never send passwords by email never paste passwords beside the workstation install and regularly (weekly) update virus protection avoid sending attachments never open unsolicited attachments, always check and double-check the attachment’s file extension never open unexpected file with extensions EXE COM DOC DLL PIF LNK VBS (Windows does not show LNK and PIF extensions, you will be taken for a ride by MS ) firewall may protect both yourself and the world but may also cheat you) Medical Informatics:  Medical Informatics DECISION SUPPORT AND THEORY Download content as MS PPT presentation The Fundamental Principle of Decision Theory:  The Fundamental Principle of Decision Theory THE BAYES THOREM [New Knowledge] = [Experimentation] x [Old Knowledge] Application: Making Diagnosis [Old Knowledge] - we know disease D prevalence, p(D) [New Knowledge] - we need to know if the patient has disease D if he has symptom S, p(D|S) [Experimentation] - Bayes Theorem builds the Likelihood Function: L(D|S) = p(S|D) / {p(S|D) p(D) + p(S|’D) p(‘D)} Now this Likelihood Function modifies the Old Knowledge: p(D|S) = L(D|S) p(D) Medical Decision Support:  Medical Decision Support to mention a few Clinical Systems Financial Medical Records Comprehensive Diagnostic Systems QMR, Iliad, DXPlain, etc. Pharmaceutical Prescriptions Research Data Mining Health System Modeling Medical Decision Support Clinical Systems:  Medical Decision Support Clinical Systems Computerized Medical Record systems are discussed in class: TMR -- CMR from Duke Medical Center MedicaLogica Pharmaceutical System for Multiple Drug Therapy in ICU, Pharm-X is discussed in class Comprehensive system for VCU HealthSystem (by CERNER) is discussed in class. Medical Decision Support Diagnostic Systems:  Medical Decision Support Diagnostic Systems Knowledge Engineering, Expert Systems, AI are discussed in class observations knowledge base decision mechanism diagnoses explanations feedback to adjust observations Medical Decision Support Health Systems Modeling - 1:  Medical Decision Support Health Systems Modeling - 1 Primary Care Physician Supply Crisis Medical Decision Support Health Systems Modeling - 2:  Medical Decision Support Health Systems Modeling - 2 Delays in getting the policy change bring fruits Medical Decision Support Health Systems Modeling - 2:  Medical Decision Support Health Systems Modeling - 2 The simulation model will give a foresight Medical Decision Support Measurement and Statistics:  Medical Decision Support Measurement and Statistics Use only reasonable precision, round up numbers to convey your purpose Computer arithmetic is more precise than any measurement Medical Informatics:  Medical Informatics RECOMMENDED RESOURCE FOR ADVANCED STUDIES Download content as MS PPT presentation Handbook of Medical Informatics:  Handbook of Medical Informatics http://www.mieur.nl/mihandbook http://www.mihandbook.stanford.edu/ MCV Course for 4th year medical students Education vs Vocational Training:  Education vs Vocational Training Medical Informatics:  Medical Informatics THE END OF PRESENTATION MCV Course for 4th year medical students Download content as MS PPT presentation

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